Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA.
University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and.
Cornea. 2023 Nov 1;42(11):1432-1438. doi: 10.1097/ICO.0000000000003248. Epub 2023 Feb 6.
Small-fiber neuropathy (SFN) is known to be associated with Sjögren disease (SjD), and in vivo corneal confocal microscopy can identify features compatible with SFN. Here, we performed a descriptive study to identify features of SFN of the corneal subbasal nerve plexus using in vivo confocal microscopy.
We recruited 10 participants from the Sjögren's International Collaborative Clinical Alliance (SICCA), 1 new participant (in an effort to expand the SICCA cohort), and 22 healthy controls. All participants underwent slit-lamp examination and in vivo confocal microscopy of the central corneal subbasal nerve plexus centered about the central whorl to create a 30-image montage. Each image was analyzed with automated software (ACCmetrics, Manchester, United Kingdom) to produce 7 nerve metrics. We performed t-tests and age-adjusted regressions to make comparisons of nerve metrics between participants with SjD and healthy controls.
Most nerve metrics were significantly lower in participants with SjD compared with healthy controls. The mean corneal nerve fiber density was found to be 3.5 mm/mm 2 in participants with SjD compared with 10.6 mm/mm 2 in healthy controls (95% confidence interval, -8.4 to -0.93; P = 0.02). Within the 11 participants with SjD, 22 eyes were analyzed on confocal microscopy, and 16 of those eyes (from 9 individuals) did not have an identifiable central whorl. Within the 22 healthy controls, 22 eyes (right eye alone) were analyzed on confocal microscopy, and 21 of those eyes had an identifiable central whorl.
SjD exhibits lower corneal nerve metrics compared with healthy controls. These findings suggest that features compatible with SFN can distinguish SjD from healthy controls and may serve as a potential novel biomarker in identifying SjD.
已知小纤维神经病（SFN）与干燥综合征（SjD）有关，并且体内角膜共聚焦显微镜可以识别与 SFN 相符的特征。在此，我们进行了一项描述性研究，以使用体内共聚焦显微镜来识别角膜基底神经丛的 SFN 特征。
我们从干燥综合征国际协作临床联盟（SICCA）招募了 10 名参与者、1 名新参与者（旨在扩大 SICCA 队列）和 22 名健康对照者。所有参与者均接受裂隙灯检查和中央角膜基底神经丛的体内共聚焦显微镜检查，以中央轮为中心创建 30 张图像蒙太奇。使用自动软件（英国曼彻斯特的 ACCmetrics）分析每个图像，以产生 7 种神经指标。我们进行了 t 检验和年龄调整回归，以比较 SjD 参与者和健康对照者之间的神经指标。
与健康对照组相比，SjD 参与者的大多数神经指标均显着降低。 SjD 参与者的角膜神经纤维密度平均值为 3.5mm/mm 2，而健康对照组为 10.6mm/mm 2（95%置信区间，-8.4 至-0.93；P=0.02）。在 11 名 SjD 参与者中，有 22 只眼睛进行了共聚焦显微镜检查，其中 16 只眼睛（来自 9 个人）没有可识别的中央轮。在 22 名健康对照者中，有 22 只眼睛（仅右眼）进行了共聚焦显微镜检查，其中 21 只眼睛有可识别的中央轮。
SjD 与健康对照组相比，角膜神经指标较低。这些发现表明，与 SFN 相符的特征可以将 SjD 与健康对照组区分开来，并且可能成为识别 SjD 的潜在新型生物标志物。
