SCI TOP 10

当前位置:首页>SCI TOP 10

治疗角膜神经病变患者畏光症的自体血清泪液:疗效及采用体内共聚焦显微镜对其进行评价

Aggarwal S, Kheirkhah A, Cavalcanti BM

期刊名称:OCUL SURF 眼球表面

卷期:第13卷(2015年)3期

摘要

 目的:角膜神经病变患者可能出现畏光症;即光敏感性增加,需要经常采用常规裂隙灯检查。本研究旨在评价自体血清泪液(AST)对角膜神经病变患者严重畏光性的疗效,以及通过体内共聚焦显微镜(IVCM)将该病的临床表现与角膜皮下神经的改变进行关联。

研究方法:展开回顾性病例对照研究,对16例神经病变诱发的严重畏光性患者与对照组的16例正常受试者进行比较。记录症状的严重程度,临床检查结果以及双侧角膜IVCM扫描结果。

研究结果:所有患者存在极其严重的畏光性(8.8±1.1),但未并发生眼表疾病。与对照组相比,患者组基线处的皮下神经数量显著降低;总神经长度(分别为9208±1264和24714±1056μm /mm(2);P<0.001),总神经数量(分别为9.6±1.4和28.6±2.0;P<0.0001)。从形态上看,我们发现存在明显增加的反射率(2.9±0.2对1.8±0.1;P<0.0001),串珠现象(比例为93.7%),以及神经源性肿瘤(比例为62.5%)。AST(3.6±2.1个月)显著减轻了症状的严重程度(1.6±1.7;P = 0.02)。IVCM则显示神经参数(P<0.005),总神经长度(15451±1595m/mm(2))、数量(13.9±2.1),以及反射率(1.9±0.1)有了显著改善。并且串珠现象和神经瘤分别只在56.2%和7.6%的患者中出现。

结论:角膜病变引起的畏光性表明角膜神经发生了深刻的改变。AST通过神经再生恢复神经形态,这与患者报道的畏光性改善相关。这些数据支持角膜神经损伤导致三叉神经传入通路发生改变从而产生畏光性的理论。

OBJECTIVE: Patients suffering from corneal neuropathy may present with photoallodynia; i.e., increased light sensitivity, frequently with a normal slit-lamp examination. This study aimed to evaluate the efficacy of autologous serum tears (AST) for treatment of severe photoallodynia in corneal neuropathy and to correlate clinical findings with corneal subbasal nerve alterations by in vivo confocal microscopy (IVCM).

METHODS: Retrospective case control study with 16 patients with neuropathy-induced severe photoallodynia compared to 16 normal controls. Symptom severity, clinical examination and bilateral corneal IVCM scans were recorded.

RESULTS: All patients suffered from extreme photoallodynia (8.8+/-1.1) with no concurrent ocular surface disease. Subbasal nerves were significantly decreased at baseline in patients compared to controls; total nerve length (9208+/-1264 vs 24714+/-1056 mum/mm(2); P<.0001) and total nerve number (9.6+/-1.4 vs 28.6+/-2.0; P<.0001), respectively. Morphologically, significantly increased reflectivity (2.9+/-0.2 vs 1.8+/-0.1; P<.0001), beading (in 93.7%), and neuromas (in 62.5%) were seen. AST (3.6+/-2.1 months) resulted in significantly decreased symptom severity (1.6+/-1.7; P=.02). IVCM demonstrated significantly improved nerve parameters (P<.005), total nerve length (15451+/-1595 mum/mm(2)), number (13.9+/-2.1), and reflectivity (1.9+/-0.1). Beading and neuromas were seen in only 56.2% and 7.6% of patients.

CONCLUSION: Patients with corneal neuropathy-induced photoallodynia show profound alterations in corneal nerves. AST restores nerve topography through nerve regeneration, and this correlated with improvement in patient-reported photoallodynia. The data support the notion that corneal nerve damage results in alterations in afferent trigeminal pathways to produce photoallodynia.

点击下载

CopyRight 2016  兴齐100版权所有 京ICP证060955号
技术支持:示剑网络   http://100.sinqi.com/