FS-LASIK术后伴有和不伴有慢性眼痛的干眼症患者的临床特征及神经肽分析
Analysis of Clinical Characteristics and Neuropeptides in Patients with Dry Eye with and without Chronic Ocular Pain after FS-LASIK.
作者信息
Zhao Lu, Zhou Yifan, Duan Hongyu, Zhang Yu, Ma Baikai, Yang Tingting, Chen Jiawei, Chen Yueguo, Qi Hong
机构信息
Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Peking University Health Science Center, Institute of Medical Technology, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
出版信息
Ophthalmol Ther. 2024 Mar;13(3):711-723. doi: 10.1007/s40123-023-00861-3. Epub 2024 Jan 8.
INTRODUCTION
Chronic ocular pain, particularly prevalent in patients with dry eye disease and post-femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) surgery, presents with unclear clinical characteristics and an undefined pathogenesis. In this study, we aimed to compare clinical characteristics and tear neuropeptide concentrations in patients with dry eye disease (DED) with and without chronic ocular pain following FS-LASIK, and investigate correlations between ocular pain, clinical characteristics, and tear neuropeptide levels.
METHODS
Thirty-eight post-FS-LASIK patients with DED were assigned to two groups: those with chronic ocular pain and those without chronic ocular pain. Dry eye, ocular pain, and mental health-related parameters were evaluated using specific questionnaires and tests. The morphology of corneal nerves and dendritic cells (DCs) was evaluated by in vivo confocal microscopy. Function of corneal innervation was evaluated by corneal sensitivity. Concentrations of tear cytokines (interleukin [IL]-6, IL-23, IL-17A, and interferon-γ) and neuropeptides (α-melanocyte-stimulating hormone, neurotensin, β-endorphin, oxytocin, and substance P [SP]) were measured using the Luminex assay.
RESULTS
Most patients with chronic ocular pain experienced mild to moderate pain; the most common types included stimulated pain (provoked by wind and light), burning pain, and pressure sensation. More severe dry eye (P < 0.001), anxiety symptoms (P = 0.026), lower Schirmer I test values (P = 0.035), lower corneal nerve density (P = 0.043), and more activated DCs (P = 0.041) were observed in patients with ocular pain. Tear concentrations of SP and oxytocin were significantly higher in patients with ocular pain (P = 0.001, P = 0.021, respectively). Furthermore, significant correlations were observed among ocular pain severity, SP, and anxiety levels.
CONCLUSIONS
Patients with DED after FS-LASIK who have chronic ocular pain show more severe ocular and psychological discomfort and higher tear levels of neuropeptides. Furthermore, ocular pain severity is correlated with tear SP levels.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT05600985.
引言
慢性眼痛在干眼症患者和飞秒激光制瓣准分子原位角膜磨镶术（FS-LASIK）术后患者中尤为普遍，其临床特征尚不明确，发病机制也未明。在本研究中，我们旨在比较FS-LASIK术后有和无慢性眼痛的干眼症（DED）患者的临床特征和泪液神经肽浓度，并研究眼痛、临床特征和泪液神经肽水平之间的相关性。
方法
38例FS-LASIK术后的DED患者被分为两组：有慢性眼痛的患者和无慢性眼痛的患者。使用特定问卷和测试评估干眼、眼痛和心理健康相关参数。通过活体共聚焦显微镜评估角膜神经和树突状细胞（DC）的形态。通过角膜敏感性评估角膜神经支配功能。使用Luminex检测法测量泪液细胞因子（白细胞介素[IL]-6、IL-23、IL-17A和干扰素-γ）和神经肽（α-黑素细胞刺激素、神经降压素、β-内啡肽、催产素和P物质[SP]）的浓度。
结果
大多数有慢性眼痛的患者经历轻度至中度疼痛；最常见的类型包括刺激性疼痛（由风和光引起）、灼痛和压迫感。在有眼痛的患者中观察到更严重的干眼（P < 0.001）、焦虑症状（P = 0.026）、更低的Schirmer I试验值（P = 0.035）、更低的角膜神经密度（P = 0.043）和更多活化的DC（P = 0.041）。有眼痛的患者泪液中SP和催产素的浓度显著更高（分别为P = 0.001，P = 0.021）。此外，在眼痛严重程度、SP和焦虑水平之间观察到显著相关性。
结论
FS-LASIK术后有慢性眼痛的DED患者表现出更严重的眼部和心理不适以及更高的泪液神经肽水平。此外，眼痛严重程度与泪液SP水平相关。
试验注册
ClinicalTrials.gov标识符：NCT05600985。
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