From the Stein Eye Institute (D.N., C.B., S.S.M.F., R.U., S.X.D.), David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Department of Ophthalmology (D.N.), Banphaeo General Hospital, Samut Sakhon, Thailand.
From the Stein Eye Institute (D.N., C.B., S.S.M.F., R.U., S.X.D.), David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Centre de Recherche des Cordeliers (C.B.), INSERM 1138, Paris Cité Université, AP-HP, F-75014, Paris, France.
Am J Ophthalmol. 2024 Nov;267:249-256. doi: 10.1016/j.ajo.2024.06.022. Epub 2024 Jun 29.
To investigate whether neurotrophic keratopathy is present in limbal stem cell deficiency (LSCD), by measuring corneal sensation and characterizing corneal subbasal nerve plexus.
Prospective, cross-sectional, case-control comparative study.
A total of 46 eyes with LSCD and 14 normal eyes were recruited from 2019 to 2022. Corneal sensation was measured using a Cochet-Bonnet esthesiometer, and subbasal nerve plexus was imaged using in vivo confocal microscopy (IVCM) at the central cornea and 4 limbal regions. Subbasal nerve density (SND, number of nerves/mm), subbasal nerve length (SNL, total length of nerves/mm) and subbasal nerve branch density (SNBD, number of branches/mm) were quantified. LSCD was graded to stage 1, 2, and 3 using a previously established staging method consisting of clinical scores, basal cell density, central corneal epithelial thickness, and SNL.
The mean (±SD) cornea sensation in the central cornea and limbus were 29.2 ± 21.5 and 33.6 ± 15.1 mm in the LSCD group and 57.6 ± 5.8 and 54.3 ± 4.7 mm in the control group, respectively (all P < .001). In sectoral LSCD, the corneal sensation in the affected regions (29.1 ± 17.6 mm) decreased significantly compared to the unaffected regions (41.4 ± 18.2 mm, P < .001). Central corneal SND, SNL, and SNBD were reduced by 84.6%, 82.6%, and 89.2%, respectively, in LSCD compared to controls (all P < 0.05). The central corneal sensation negatively correlated with the severity of LSCD (rho = -0.64, P < .0001) and positively correlated with SND, SNL, and SNBD (rho = 0.63, 0.66, and 0.56, respectively; all P < .001).
Corneal sensation was reduced in eyes with LSCD. The degree of corneal sensation reduction positively correlated with the severity of LSCD. This finding demonstrated the coexistence of neurotropic keratopathy in LSCD.
通过测量角膜感觉和描述角膜基质下神经丛，来研究神经营养性角膜病变是否存在于角膜缘干细胞缺乏症（LSCD）中。
前瞻性、横断面、病例对照比较研究。
2019 年至 2022 年期间，共招募了 46 只患有 LSCD 的眼睛和 14 只正常眼睛。使用 Cochet-Bonnet 触觉计测量角膜感觉，在中央角膜和 4 个角膜缘区域使用活体共聚焦显微镜（IVCM）成像来描绘基质下神经丛。量化基质下神经密度（SND，神经/mm 数）、基质下神经长度（SNL，神经/mm 总长度）和基质下神经分支密度（SNBD，分支/mm 数）。使用先前建立的分级方法，根据临床评分、基底细胞密度、中央角膜上皮厚度和 SNL 将 LSCD 分为 1 期、2 期和 3 期。
LSCD 组中央角膜和角膜缘的平均（±SD）角膜感觉分别为 29.2 ± 21.5mm 和 33.6 ± 15.1mm，对照组分别为 57.6 ± 5.8mm 和 54.3 ± 4.7mm（均 P <.001）。在扇形 LSCD 中，受累区域（29.1 ± 17.6mm）的角膜感觉明显低于未受累区域（41.4 ± 18.2mm，P <.001）。与对照组相比，LSCD 组中央角膜 SND、SNL 和 SNBD 分别降低了 84.6%、82.6%和 89.2%（均 P <.05）。中央角膜感觉与 LSCD 的严重程度呈负相关（rho = -0.64，P <.0001），与 SND、SNL 和 SNBD 呈正相关（rho = 0.63、0.66 和 0.56，均 P <.001）。
LSCD 患者的角膜感觉降低。角膜感觉减退的程度与 LSCD 的严重程度呈正相关。这一发现表明 LSCD 中存在神经营养性角膜病变。
