Corneal Sensitivity in Diabetic Patients Subjected to Retinal Laser Photocoagulation
Corneal Sensitivity in Diabetic Patients Subjected to Retinal Laser Photocoagulation
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DOI：
10.1167/iovs.10-7054
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发表时间：
2011-07-01
影响因子：
4.4
通讯作者：
Gallar, Juana
中科院分区：
文献类型：
--
作者：
Neira-Zalentein, Waldir;Holopainen, Juha M.;Gallar, Juana
目的.目的探讨糖尿病（DM）1型和DM 2型视网膜病变患者角膜对不同刺激方式的敏感性变化，以及氩激光光凝是否加重糖尿病患者的敏感性丧失。在52例DM 1（n = 35）或DM 2（n = 17）患者和27例健康受试者的一只随机眼中测定角膜对不同刺激方式的敏感性。从所有患者中获得病史，包括年龄、性别、从DM诊断开始的时间、糖尿病类型、从视网膜病变发作开始的时间、糖尿病视网膜病变的类型和氩激光治疗的类型。角膜敏感性用气体触觉计测定。机械，化学和热（热和冷）刺激施加在中央角膜。与对照组相比，DM患者对选择性机械、化学和冷刺激的敏感性阈值显著较高。DM 2患者对机械和化学刺激的敏感阈值高于DM 1患者。在DM 1患者中，机械阈值在DM诊断后随时间增加。对化学或热刺激的敏感性阈值与患者年龄、视网膜病变类型或诊断时间之间没有相关性。激光治疗进一步损害了角膜敏感性。糖尿病患者角膜对机械、化学和热刺激的敏感性降低，表明糖尿病均匀地影响支配角膜的不同类型的感觉神经元。角膜敏感性似乎在DM 2中比在DM 1中更受干扰。糖尿病患者的激光治疗会进一步损害角膜敏感性，这可能是睫状神经物理损伤的结果。（Invest Ophthalmol维斯科学。2011;52：6043-6049）DOI：10.1167/iovs.10-7054
PURPOSE. To determine the changes in corneal sensitivity to different stimulus modalities in diabetes mellitus (DM)1 and DM2 patients with retinopathy, and to explore whether argon laser photocoagulation exacerbates sensitivity loss in diabetic patients.METHODS. Corneal sensitivity to different modalities of stimulus was determined in one randomized eye in 52 patients with DM1 (n = 35) or DM2 (n = 17), and in 27 healthy subjects. Medical history was obtained from all the patients, including age, sex, time from DM diagnosis, type of diabetes, time from onset of retinopathy, type of diabetic retinopathy, and type of argon laser treatment. Corneal sensitivity was determined using a gas esthesiometer. Mechanical, chemical, and thermal (heat and cold) stimuli were applied on the central cornea.RESULTS. Sensitivity thresholds to selective mechanical, chemical, and cold stimulation were significantly higher in DM patients compared to controls. Sensitivity threshold to mechanical and chemical stimuli was higher in DM2 than in DM1 patients. In DM1 patients, mechanical threshold increased with time after DM diagnosis. No correlation was found between sensitivity thresholds to chemical or thermal stimulation and the age of the patient, type of retinopathy, or time from its diagnosis. Laser treatment generated a further impairment of corneal sensitivity.CONCLUSIONS. Corneal sensitivity to mechanical, chemical, and thermal stimulation is decreased in DM patients, suggesting that diabetes affects homogeneously the different types of sensory neurons innervating the cornea. Corneal sensitivity appears to be more disturbed in DM2 than in DM1. Laser treatment of DM patients generates a further impairment in corneal sensitivity, probably as the result of physical damage to ciliary nerves. (Invest Ophthalmol Vis Sci. 2011;52:6043-6049) DOI:10.1167/iovs.10-7054