干眼病中角膜基底下轮状神经模式的几何特征：体内共聚焦显微镜研究。

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2024-12-05 DOI:10.1016/j.xops.2024.100669

Ziqing Feng MD, Kang Yu MD, Yupei Chen MS, Gengyuan Wang MS, Yuqing Deng MD, Wei Wang MD, Ruiwen Xu MD, Yimin Zhang MD, Peng Xiao PhD, Jin Yuan MD, PhD

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引用次数: 0

摘要

目的：探讨干眼病（DED）不同严重程度和亚型的轮状角膜神经的几何特征，初步探讨其诊断能力。设计：横断面研究。参与者：29名健康受试者（51只眼）和62名DED患者（95只眼）。方法：所有受试者均行全面眼科检查、干眼检查和活体共聚焦显微镜观察下轮区（IW）的轮状角膜神经和角膜中央的直神经。利用分形维数（CNDf）、多重分形维数（CND0）、弯曲度（CNTor）、纤维长度（CNFL）和分支点数对角膜神经的结构进行了提取和表征。主要结局指标：量化的轮状角膜神经指标在不同严重程度和由DED症状和体征定义的亚型组中的特征。结果：与健康对照组相比，IW患者早在1级DED时CNDf、CND0、CNFL均显著降低（P < 0.05），而CNTor升高（P < 0.05）。这些参数在直神经中没有明显变化。随着DED严重程度的增加，3级DED与1级DED相比，轮状神经的CNDf和CNFL进一步降低。缺水性DED与蒸发性DED相比，神经纤维损失显著（P < 0.05）。轮状神经指标分别与眼部不适、泪膜破裂时间、泪液分泌和角膜荧光素染色相关（P < 0.05）。螺旋形神经与线状神经的合并参数在诊断DED时曲线下面积为0.910。结论：IW的几何参数可能有助于优化DED的分期。可靠客观的轮状角膜神经测量可能有助于患者分层和诊断DED。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。

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Geometrical Features of Subbasal Corneal Whorl-like Nerve Patterns in Dry Eye Disease

Purpose

To investigate the geometrical feature of the whorl-like corneal nerve in dry eye disease (DED) across different severity levels and subtypes and preliminarily explore its diagnostic ability.

Design

Cross-sectional study.

Participants

The study included 29 healthy subjects (51 eyes) and 62 DED patients (95 eyes).

Methods

All subjects underwent comprehensive ophthalmic examinations, dry eye tests, and in vivo confocal microscopy to visualize the whorl-like corneal nerve at the inferior whorl (IW) region and the straight nerve at the central cornea. The structure of the corneal nerve was extracted and characterized using the fractal dimension (CND_f), multifractal dimension (CND₀), tortuosity (CNTor), fiber length (CNFL), and numbers of branching points.

Main Outcome Measures

The characteristics of quantified whorl-like corneal nerve metrics in different groups of severity and subtype defined by symptoms and signs of DED.

Results

Compared with the healthy controls, the CND_f, CND₀, and CNFL of the IW decreased significantly as early as grade 1 DED (P < 0.05), whereas CNTor increased (P < 0.05). These parameters did not change significantly in the straight nerve. As the DED severity increased, CND_f and CNFL in the whorl-like nerve further decreased in grade 3 DED compared with grade 1. Significant nerve fiber loss was observed in aqueous-deficient DED compared with evaporative DED (P < 0.05). Whorl-like nerve metrics correlated with ocular discomfort, tear film break-up time, tear secretion, and corneal fluorescein staining, respectively (P < 0.05). Furthermore, merging parameters of whorl-like and linear nerve showed an area under the curve value of 0.910 in diagnosing DED.

Conclusions

Geometrical parameters of IW could potentially allow optimization of the staging of DED. Reliable and objective measurements for the whorl-like cornea nerve might facilitate patient stratification and diagnosis of DED.