Corneal sensation and subbasal nerve alterations in patients with herpes simplex keratitis: an in vivo confocal microscopy study.
Corneal sensation and subbasal nerve alterations in patients with herpes simplex keratitis: an in vivo confocal microscopy study.
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DOI：
10.1016/j.ophtha.2010.07.010
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发表时间：
2010-10
期刊：
影响因子：
13.7
通讯作者：
Pavan-Langston D
中科院分区：
文献类型：
--
作者：
Hamrah P;Cruzat A;Dastjerdi MH;Zheng L;Shahatit BM;Bayhan HA;Dana R;Pavan-Langston D
应用活体共焦显微镜(IVCM)研究单纯疱疹病毒性角膜炎(HSK)患者的角膜知觉与角膜基底神经的密度和形态的关系。前瞻性、横断面、对照、单中心研究。对31只确诊为急性(n=7)或慢性(n=24)单纯疱疹病毒性角膜炎(HSK)的患者及对侧正常对照眼(n=15)进行对比研究。所有患者和对照组均行双眼中央角膜IVCM(Confoscan 4，Nidek)和角膜感觉测量仪(Cochet-Bonnet)检查。将患者分为正常(>；5.5 cm)、轻度(>；2.5~5.5 cm)和重度(≤2.5 cm)感觉丧失3组。观察IVCM术后角膜神经密度、总神经数目、主神经干、分支和曲度的变化，并与角膜知觉、病程和复发次数相关。平均神经密度(448.9±409.3比2,258.4±989.0μm/帧)、总神经数(5.2±4.5比13.1±3.8)、主干(2.3±1.6比4.7±1.2)和神经分支(3.2±4.3比9.8±3.3)均较对照组明显减少(P<0.0 5)。健眼的平均神经密度(992.7±465.0μm/帧)、总神经数(7.80±3.33)和分支数(4.5%±2.3%)均显著低于对照组(p<；0.002)。在所有亚组中，HSK患者的神经密度、总神经计数和主干减少与角膜知觉显著相关(p<；0.001)。神经密度在感染后几天内下降，并与HSK患者的发作频率相关(p<；0.02)。体内共聚焦显微镜显示，单纯疱疹病毒(HSV)感染后，HSK患者角膜知觉的丧失与基底下神经丛的显著减少密切相关。令人惊讶的是，与正常受试者相比，临床未受影响的对侧眼睛也显示出基底下神经丛的减少，显示出明显的单侧疾病的双侧神经改变。
To study and correlate corneal sensation in patients with herpes simplex keratitis (HSK) with density and morphology of subbasal corneal nerves by in vivo confocal microscopy (IVCM). Prospective, cross-sectional, controlled, single-center study. Thirty-one eyes with the diagnosis of acute (n=7) or chronic (n=24) HSK and the contralateral clinically unaffected eyes were studied and compared to normal controls (n=15). IVCM (Confoscan 4, Nidek) and corneal esthesiometry (Cochet-Bonnet) of the central cornea were performed bilaterally in all patients and controls. Patients were grouped into normal (>5.5 cm), mild (>2.5 to 5.5cm) and severe (≤2.5 cm) loss of sensation. Changes in corneal nerve density, total nerve number, main nerve trunks, branching and tortuosity were evaluated after IVCM and correlated to corneal sensation, disease duration, and number of recurrences. HSK eyes, as compared to controls, demonstrated significant (p<0.001) decrease in mean nerve density (448.9±409.3 vs. 2,258.4±989.0 μm/frame), total nerve number (5.2±4.5 vs. 13.1±3.8), main nerve trunks (2.3±1.6 vs. 4.7±1.2) and nerve branches (3.2 ± 4.3 vs. 9.8±3.3). In contralateral unaffected eyes, mean nerve density (992.7±465.0 μm/frame), total nerve number (7.8±3.3), and branches (4.5±2.3) were significantly decreased as compared to controls (p<0.002). Reduced nerve density, total nerve count and main trunks in HSK eyes were significantly correlated with corneal sensation across all subgroups (p<0.001). Nerve density decreased within days of infection and was correlated to frequency of episodes in patients with HSK (p<0.02). In vivo confocal microscopy reveals that the loss of corneal sensation in HSK correlates strongly with profound diminishment of the subbasal nerve plexus after herpes simplex virus (HSV) infection. Surprisingly, the contralateral clinically unaffected eyes also demonstrated a diminishment of the subbasal nerve plexus, as compared to normal subjects, revealing bilateral nerve alteration in an apparently unilateral disease.
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