Laser scanning in vivo confocal microscopy and quantitative aesthesiometry reveal decreased corneal innervation and sensation in keratoconus
Laser scanning in vivo confocal microscopy and quantitative aesthesiometry reveal decreased corneal innervation and sensation in keratoconus
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DOI：
10.1038/eye.2008.52
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发表时间：
2009-03-01
期刊：
影响因子：
3.9
通讯作者：
McGhee, C. N. J.
中科院分区：
文献类型：
--
作者：
Patel, D. V.;Ku, J. Y. F.;McGhee, C. N. J.
目的对圆锥角膜患者的角膜上皮细胞和基底下神经丛的激光扫描共聚焦显微镜图像进行定量分析，并将其与角膜敏感度进行相关性分析。12例圆锥角膜患者从未戴过隐形眼镜(K-NCL)。15例圆锥角膜患者常规配戴隐形眼镜(K-CL)。采用裂隙灯生物显微镜、OrbScan地形图、非接触式角膜感受仪和激光扫描活体共聚焦显微镜对所有患者进行检查。结果K-CL患者的中央角膜知觉明显低于正常对照组(P=0.028)。而角膜知觉正常组与K-NCL组比较差异无统计学意义(P=0.059)。所有圆锥角膜受试者的基底下神经密度(P<；0.001)和基底上皮密度(P<；0.001)均显著低于正常。中央角膜知觉仅与基底下神经密度显著相关(P=0.001)，与任何基础上皮参数均无显著相关。基底神经密度与基底上皮密度呈显著正相关(P<；0.001)。结论圆锥角膜的角膜神经支配、感觉和基底上皮密度均降低。这项研究的结果提供了强有力的证据，表明基底下神经和基底上皮都可能参与圆锥角膜的发病机制，尽管尚不确定这些改变是原发的还是继发性的。
Purpose The purpose of this study was to quantitatively analyse laser scanning in vivo confocal microscopy images of the corneal epithelium and sub-basal nerve plexus in patients with keratoconus and to correlate these microstructural observations with corneal sensitivity.Methods A total of 31 eyes of 31 normal human subjects, and 27 eyes of 27 subjects with an established diagnosis of keratoconus were recruited. Twelve subjects with keratoconus had never worn contact lenses (K-NCL). Fifteen subjects with keratoconus wore contact lenses routinely (K-CL). All eyes were examined using slit-lamp biomicroscopy, Orbscan topography, non-contact corneal aesthesiometry, and laser scanning in vivo confocal microscopy.Results Central corneal sensation was significantly lower in K-CL compared to normal (P = 0.028). However, there was no significant difference in corneal sensation between the normal and K-NCL groups (P = 0.059). Both sub-basal nerve density (P < 0.001) and basal epithelial density (P < 0.001) were significantly lower than normal in all keratoconic subjects. Central corneal sensation was only significantly correlated with sub-basal nerve density (P = 0.001) and was not significantly correlated with any of the basal epithelial parameters. Sub-basal nerve density showed significant positive correlation with basal epithelial density (P < 0.001).Conclusion This quantitative study reveals decreased corneal innervation, sensation, and basal epithelial density in keratoconus. The results of this study provide strong evidence that both the sub-basal nerves and the basal epithelium may be involved in the pathogenesis of keratoconus, although it is uncertain whether these are primary or secondary changes.