Structural and functional changes in corneal innervation after laser in situ keratomileusis and their relationship with dry eye
Structural and functional changes in corneal innervation after laser in situ keratomileusis and their relationship with dry eye
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DOI：
10.1007/s00417-015-3120-1
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发表时间：
2015-11-01
影响因子：
2.7
通讯作者：
Golebiowski, Blanka
中科院分区：
文献类型：
--
作者：
Chao, Cecilia;Stapleton, Fiona;Golebiowski, Blanka
LASIK术后干眼最可能的病因是角膜神经损伤;然而，LASIK术后干眼症状与神经损伤之间没有直接关系，并且关于LASIK术后干眼体征与角膜神经再支配之间关系的信息有限。泪液神经肽（SP和CGRP）在维持角膜神经健康方面很重要，但LASIK的影响尚未研究。本研究评估神经形态学，泪液神经肽，干眼的变化，以建立神经再支配和干眼之间的关系，并评估泪液神经肽在神经再支配post-LASIK。20非干眼志愿者谁经历了双边近视LASIK完成了这项研究。在LASIK术前、术后1天、1周、1个月、3个月和6个月监测角膜神经形态（密度、宽度、互连和迂曲度）、SP和CGRP浓度以及干眼。术后角膜神经形态立即下降，至术后6个月仍未恢复到术前水平（P < 0.001）。LASIK术后3个月泪液SP浓度明显升高（P < 0.001）。LASIK术后干眼神经再支配与干眼症状呈负相关，LASIK术后干眼神经再支配与干眼症状呈负相关，证实LASIK术后干眼是一种神经性疾病。这项研究是第一个证明泪液SP和LASIK术后神经再支配之间的关联，这表明操纵神经肽浓度以改善神经再支配的策略可以改善LASIK术后的眼部舒适度。
The most likely etiology of post-LASIK dry eye is corneal nerve damage; however, no direct relationship between post-LASIK dry eye symptoms and nerve damage has been established, and limited information is available about the relationship between dry eye signs and corneal reinnervation after LASIK. Tear neuropeptides (SP and CGRP) are important in the maintenance of corneal nerve health, but the impact of LASIK has not yet been studied. This study evaluated changes in nerve morphology, tear neuropeptide, and dry eye, so as to establish the relationship between reinnervation and dry eye and to assess the role of tear neuropeptides in reinnervation post-LASIK.Twenty non-dry eye volunteers who had undergone bilateral myopic-LASIK completed this study. Corneal nerve morphology (density, width, interconnections, and tortuosity), SP and CGRP concentration, and dry eye were monitored over time prior to, 1 day, 1 week, 1, 3, and 6 months post-LASIK.Dry eye symptoms and tear function, except for osmolarity (P = 0.003), remained unchanged post-LASIK. Corneal nerve morphology decreased immediately, and did not return to preoperative levels by 6 months post-LASIK (P < 0.001). Increased tear SP concentration was observed 3 months post-LASIK (P < 0.001). Associations between reinnervation as measured by increased density and lower tear SP (P = 0.03), and between increased density and decreased dry eye symptoms (P = 0.01) were found post-LASIK.An inverse relationship between reinnervation post-LASIK and dry eye symptoms was found, confirming that post-LASIK dry eye is a neuropathic disease. This study is the first to demonstrate an association between tear SP and post-LASIK reinnervation, suggesting that strategies for manipulating neuropeptide concentration to improve reinnervation may improve ocular comfort post-LASIK.