Degeneration and Regeneration of Subbasal Corneal Nerves after Infectious Keratitis: A Longitudinal In Vivo Confocal Microscopy Study.
Degeneration and Regeneration of Subbasal Corneal Nerves after Infectious Keratitis: A Longitudinal In Vivo Confocal Microscopy Study.
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DOI：
10.1016/j.ophtha.2015.06.047
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发表时间：
2015-11
期刊：
影响因子：
13.7
通讯作者：
Hamrah P
中科院分区：
文献类型：
--
作者：
Müller RT;Abedi F;Cruzat A;Witkin D;Baniasadi N;Cavalcanti BM;Jamali A;Chodosh J;Dana R;Pavan-Langston D;Hamrah P
目的：应用活体共聚焦显微镜（IVCM）观察感染性角膜炎（IK）患者急性期、停药期和恢复期角膜基底下神经的纵向变化。前瞻性、纵向、病例对照、单中心研究。诊断为细菌性角膜炎（n=28）、真菌性角膜炎（n=15）和阿米巴性角膜炎（n=13）的56例患者的五十六只眼纳入本研究。正常志愿者30例30眼为对照组。使用Heidelberg Retina Tomograph 3/罗斯托克角膜模块（Heidelberg Engineering，德国）前瞻性地进行中央角膜的角膜感觉和系列IVCM。在3个时间点评估IVCM图像：患者首次就诊角膜服务时，停止抗菌治疗时，以及感染消退后6个月。在随访期间评估总神经数量和长度、主要神经干、分支和角膜感觉。在所有亚组中，与对照组相比，IK眼的角膜神经在急性期显著减少，总神经长度为5.47 ± 0.69与20.59 ± 1.06 mm/mm 2; p<0.0001。在治疗停止时，IK患者的角膜神经已经再生，包括总神经长度（8.49 ± 0.94; p=0.02）和神经分支长度（4.80 ± 0.37; p=0.005）。在恢复期，感染消退后，角膜神经进一步再生，包括总神经长度（12.13 ± 1.97; p=0.005），主要神经干长度（5.80 ± 1.00; p=0.01）和神经分支长度（6.33 ± 0.76; p=0.003），但与对照组相比仍显著较低（所有参数p<0.05）。角膜变性和再生与角膜感觉相关（r=0.47，p=0.0009）。IK患者在感染的急性期遭受角膜神经的严重损失，在感染消退后的前六个月期间表现出角膜神经密度的增加。然而，尽管有显著的神经再生，角膜神经密度没有完全恢复，并且与对照相比仍然较低。通过提供一种客观的方法来监测角膜神经再支配，IVCM增加了潜在的重要发现，可能对临床管理和手术计划产生影响。
To investigate the longitudinal alterations of subbasal corneal nerves in patients with infectious keratitis (IK) during acute phase, cessation of treatment and recovery phase by in vivo confocal microscopy (IVCM). Prospective, longitudinal, case-control, single-center study. Fifty-six eyes of 56 patients with the diagnosis of bacterial (n=28), fungal (n=15), and Acanthamoeba (n=13) keratitis were included in the study. Thirty eyes of 30 normal volunteers constituted the control group. Corneal sensation and serial IVCM of the central cornea were performed prospectively, by using the Heidelberg Retina Tomograph 3/Rostock Cornea Module (Heidelberg Engineering, Germany). IVCM images were assessed at 3 time points: at the first visit of the patient to the cornea service, at cessation of antimicrobial treatment, and up to six months after the resolution of infection. Total nerve number and length, main nerve trunks, branching and corneal sensation were assessed during the follow-up period. Corneal nerves were significantly reduced during the acute phase in eyes with IK compared with controls across all subgroups, with total nerve length of 5.47 ± 0.69 vs. 20.59 ± 1.06 mm/mm2; p<0.0001. At the cessation of treatment, corneal nerves in patients with IK had regenerated, including total nerve length (8.49 ± 0.94; p=0.02) and nerve branch length (4.80 ± 0.37; p=0.005). During the recovery phase, after resolution of infection, corneal nerves further regenerated, including total nerve length (12.13 ± 1.97; p=0.005), main nerve trunk length (5.80 ± 1.00; p=0.01) and nerve branch length (6.33 ± 0.76; p=0.003) as compared to the acute phase, but were still significantly lower when compared to controls (p<0.05 for all parameters). Corneal degeneration and regeneration correlated with corneal sensation (r=0.47, p=0.0009). Patients with IK, suffering from profound loss of corneal nerves during the acute phase of infection, demonstrate an increase of corneal nerve density during the first six months after the resolution of infection. However, despite significant nerve regeneration, corneal nerve density does not fully recover and remains low as compared to controls. By providing an objective methodology to monitor corneal re-innervation, IVCM adds potentially important findings that may have implications for clinical management and surgical planning.