Autologous Serum Tears for Treatment of Photoallodynia in Patients with Corneal Neuropathy: Efficacy and Evaluation with In Vivo Confocal Microscopy.
Autologous Serum Tears for Treatment of Photoallodynia in Patients with Corneal Neuropathy: Efficacy and Evaluation with In Vivo Confocal Microscopy.
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DOI：
10.1016/j.jtos.2015.01.005
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Hamrah P
中科院分区：
文献类型：
--
作者：
Aggarwal S;Kheirkhah A;Cavalcanti BM;Cruzat A;Colon C;Brown E;Borsook D;Prüss H;Hamrah P
患有角膜神经病变的患者可能会出现光敏性疼痛；即，光敏感度增加，通常用正常的裂隙灯检查。本研究旨在评估自体血清泪液（AST）治疗角膜神经病变中严重光敏性疼痛的疗效，并通过体内共聚焦显微镜（IVCM）将其与角膜基底神经改变相关联。回顾性病例对照研究，对 16 名患有神经病引起的严重光异常疼痛的患者与 16 名正常对照进行比较。记录症状严重程度、临床检查和双侧角膜 IVCM 扫描。所有患者均患有极度光敏性疼痛（8.8±1.1），且无并发眼表疾病。与对照组相比，患者的基底下神经在基线时显着减少；总神经长度（9208 ±1264 vs 24714 ±1056 μm/mm2；p<.0001）和总神经数量（9.6±1.4 vs 28.6±2.0；p<.0001）。在形态学上，观察到反射率显着增加（2.9±0.2 vs 1.8±0.1；p<.0001）、珠状（93.7%）和神经瘤（62.5%）。 AST（3.6±2.1 个月）导致症状严重程度显着降低（1.6±1.7；p=.02）。 IVCM 证明神经参数 (p< .005)、神经总长度 (15451±1595 μm/mm2)、数量 (13.9±2.1) 和反射率 (1.9±0.1) 显着改善。仅 56.2% 和 7.6% 的患者出现珠状和神经瘤。患有角膜神经病变引起的光敏性疼痛的患者表现出角膜神经的深刻改变。 AST 通过神经再生恢复神经地形，这与患者报告的光异常疼痛的改善相关。这些数据支持这样的观点，即角膜神经损伤会导致三叉神经传入通路的改变，从而产生光敏性疼痛。
Patients suffering from corneal neuropathy may present with photoallodynia; i.e., increased light sensitivity, frequently with a normal slit-lamp examination. This study aimed to evaluate the efficacy of autologous serum tears (AST) for treatment of severe photoallodynia in corneal neuropathy and correlate with corneal subbasal nerve alterations by in vivo confocal microscopy (IVCM). Retrospective case control study with 16 patients with neuropathy-induced severe photoallodynia compared to 16 normal controls. Symptom severity, clinical examination and bilateral corneal IVCM scans were recorded. All patients suffered from extreme photoallodynia (8.8±1.1) with no concurrent ocular surface disease. Subbasal nerves were significantly decreased at baseline in patients compared to controls; total nerve length (9208 ±1264 vs 24714 ±1056 μm/mm2; p<.0001) and total nerve number (9.6±1.4 vs 28.6±2.0; p<.0001), respectively. Morphologically, significantly increased reflectivity (2.9±0.2 vs 1.8±0.1; p<.0001), beading (in 93.7%), and neuromas (in 62.5%) were seen. AST (3.6±2.1 months) resulted in significantly decreased symptom severity (1.6±1.7; p=.02). IVCM demonstrated significantly improved nerve parameters (p< .005), total nerve length (15451±1595 μm/mm2), number (13.9±2.1), and reflectivity (1.9±0.1). Beading and neuromas were seen in only 56.2% and 7.6% of patients. Patients with corneal neuropathy-induced photoallodynia show profound alterations in corneal nerves. AST restores nerve topography through nerve regeneration, and this correlated with improvement in patient-reported photoallodynia. The data support the notion that corneal nerve damage results in alterations in afferent trigeminal pathways to produce photoallodynia.
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