Corneal Nerve Pathway Function in Individuals with Dry Eye Symptoms.
Corneal Nerve Pathway Function in Individuals with Dry Eye Symptoms.
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DOI：
10.1016/j.ophtha.2020.07.061
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发表时间：
2021-04
期刊：
影响因子：
13.7
通讯作者：
Sarantopoulos CD
中科院分区：
文献类型：
--
作者：
Galor A;Felix ER;Feuer W;Levitt RC;Sarantopoulos CD
干眼症是一种多因素的慢性疾病，患病率为5-4130%。1DE症状是眼科诊所经常出现的症状，包括42种干燥感，以及眼睛疼痛(描述为灼热、疼痛和43种刺激)和与视力有关的障碍。DE症状影响生活质量，因为它们降低了工作和开展日常生活活动的能力。1有趣的是，DE 45的症状通常与DE征象不同，DE征象包括泪液生成减少、泪液蒸发增加和炎症等。对这种差异的一种解释是角膜神经对疾病的病理生理学有不同的贡献，角膜神经负责眼睛的触摸、疼痛和热感。事实上，49个更新的DE定义包括神经感觉功能障碍作为一个方面，50除了泪液和眼表异常。2然而，尚不清楚有多少51名患有DE症状的人有神经异常作为52种疾病的一个促成特征。为了解决这一认识差距，本研究旨在描述患有DE症状的个体的角膜53神经通路功能，并检查神经功能指标与DE参数之间的关系54。55这项前瞻性横断面研究在2013年10月至2017年10月期间从迈阿密退伍军人管理局(VA)眼科诊所57招募了有DE症状的退伍军人(DE 56问卷(DEQ)-5≥6)。这项研究得到了迈阿密退伍军人事务部58机构审查委员会的批准，遵守了《赫尔辛基宣言》，所有59人都提供了书面知情同意。为了改善人群的同质性，我们排除了60名有解剖异常(如翼状胬肉、角膜疤痕)、系统免疫61种疾病(如Sjögrens、移植物抗宿主病)、戴隐形眼镜和/或有角膜、青光眼或视网膜手术史的个体。6个月前有白内障手术史的63人被允许。此外，由于外用药物会影响神经功能，我们排除了使用人工泪液以外的外用药物的情况。65所有受试者填写关于DE症状的问卷，包括66项DEQ-5和眼表疾病指数(OSDI)，并接受眼表67项检查，包括：炎症反应(InflammaDry，Quidel)，泪膜破裂时间(TBUT)，角膜68染色按国家眼科学会标准3分级，局部69麻醉后Schirmer评分，Meiburn质量分级Bron分级。3采用受累较重的70只眼的数据进行分析。71我们通过检查a)角膜机械检测72呼气阈值(右眼)和b)73次表面麻醉后持续眼部疼痛(即在表面麻醉后30秒记录的0-10疼痛强度等级74评分中至少1级)来表征神经功能。美学评估从角膜到大脑皮层的整个感觉通路的敏感度，而对表面麻醉剂的76反应允许评估外周77神经活动(通过表面麻醉剂后消除疼痛)与更高-78阶伤害性神经活动(表面麻醉剂后疼痛的持续性)的贡献。采用SPSS26.0统计软件进行统计分析。使用t检验、方差分析80(ANOVA)和卡方分析比较均值和频率。P-81值和t；0.05被认为是显著的。82 403名受试者的平均年龄为61岁±10岁。90%的受试者为83名男性，44%的自认为白人，27%为西班牙裔。De症状出现在84个严重的…中
Dry eye (DE) disease is a multifactorial, chronic condition with a prevalence of 5-41 30%. 1 DE symptoms are a frequent presenting complaint to eye clinics and can include 42 sensations of dryness, as well as ocular pain (described as burning, aching, and 43 irritation) and vision-related disturbances. DE symptoms impact quality of life as they 44 reduce the ability to work and carry out activities of daily living. 1 Interestingly, DE 45 symptoms are often disparate from DE signs, which include decreased tear production, 46 increased tear evaporation, and inflammation, among others. One explanation for the 47 disparity is the variable contribution of corneal nerves, which are responsible for touch, 48 pain, and thermal sensation in the eye, to the pathophysiology of disease. In fact, the 49 updated definition for DE includes neurosensory dysfunction as a contributing facet, in 50 addition to tear and ocular surface abnormalities. 2 However, it is not known how many 51 individuals with DE symptoms have nerve abnormalities as a contributing feature of 52 disease. To address this knowledge gap, this research aimed to characterize corneal 53 nerve pathway function in individuals with DE symptoms and examine relationships 54 between metrics of nerve function and DE parameters. 55 This prospective cross-sectional study recruited veterans with DE symptoms (DE 56 Questionnaire (DEQ)-5≥ 6) from the Miami Veterans Administration (VA) eye clinic 57 between October 2013 and October 2017. The study was approved by the Miami VA 58 Institutional Review Board, adhered to the Declaration of Helsinki, and all individuals 59 provided written informed consent. To improve population homogeneity, we excluded 60 individuals with anatomic abnormalities (eg pterygium, corneal scar), systemic immune 61 diseases (eg Sjögrens, graft versus host disease), contact lens wear, and/or a history 62 of cornea, glaucoma, or retinal surgery. A history of cataract surgery> 6 months ago 63 was allowed. In addition, as topical medications can affect nerve function, we excluded 64 individuals using topical medications beyond artificial tears. 65 All individuals answered questionnaires regarding DE symptoms, including the 66 DEQ-5 and Ocular Surface Disease Index (OSDI), and underwent an ocular surface 67 examination, including: Inflammadry (Quidel), tear break up time (TBUT), corneal 68 staining graded to the National Eye Institute scale3, Schirmer score after topical 69 anesthesia, and meibum quality graded to the Bron scale. 3 Data from the more severely 70 affected eye was used for analysis. 71We characterized nerve function by examining a) corneal mechanical detection 72 threshold to air puff (in the right eye) 4 and b) the presence of persistent ocular pain after 73 placement of topical anesthesia (ie, a rating of at least 1 on a 0-10 pain intensity rating 74 scale recorded at 30 seconds after topical anesthesia). Aesthesiometry evaluates the 75 sensitivity of the entire sensory pathway from the cornea to the cerebral cortex while 76 response to topical anesthetic allows for assessment of the contribution of peripheral 77 nerve activity (indicated by elimination of pain after topical anesthetic) versus higher-78 order nociceptive nerve activity (persistence of pain after topical anesthetic). 79 All analyses were conducted with SPSS 26.0. T-tests, analysis of variance 80 (ANOVA), and chi-square analyses were used to compare means and frequencies. P-81 values< 0.05 were considered significant. 82 The mean age of the 403 individuals was 61 years±10. 90% of subjects were 83 male, 44% self-identified as white and 27% as Hispanic. DE symptoms were in the 84 severe …
影响因子：
2.4
作者：
Belmonte, Carlos
通讯作者：
Belmonte, Carlos
DOI：
10.1016/j.jtos.2017.05.002
发表时间：
2017-07
期刊：
The ocular surface
影响因子：
--
作者：
Belmonte C;Nichols JJ;Cox SM;Brock JA;Begley CG;Bereiter DA;Dartt DA;Galor A;Hamrah P;Ivanusic JJ;Jacobs DS;McNamara NA;Rosenblatt MI;Stapleton F;Wolffsohn JS
通讯作者：
Wolffsohn JS
影响因子：
4.4
作者：
Spierer, Oriel;Felix, Elizabeth R.;Galor, Anat
通讯作者：
Galor, Anat