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Abstract：
Corneal nerve damage may result in neuropathic corneal pain (NCP). Autologous serum tears (AST) have been shown to results in nerve regeneration and may help alleviate corneal pain. This study aimed to evaluate the efficacy of AST in the treatment of NCP.
This was a retrospective case-control study. Sixteen patients suffering from severe NCP and no current ocular surface disease were compared to 12 controls. In vivo confocal microscopy (IVCM) (HRT3/RCM; Heidelberg Engineering GmbH, Germany) of the central corneas was performed bilaterally. Change in pain severity (scale of 0-10), corneal nerve density, tortuosity, reflectivity and presence of beading and micro-neuromas before and after treatment were recorded.
All patients had severe pain, with a mean of 9.1 ± 0.2 (range 8-10). Subbasal nerves were significantly decreased before treatment as compared to controls, including total nerve length (10,935.5 ± 1264.3 vs. 24,714.4 ± 1056.2 μm/mm2; p < 0.0001) and total number of nerves (10.5 ± 1.4 vs. 28.6 ± 2.0; p < 0.0001), respectively. Morphologically, significantly increased reflectivity (2.9 ± 0.2 vs. 1.2 ± 0.1; p = 0.00008) and tortuosity (2.4 ± 0.2 vs. 1.7 ± 0.1; p = 0.001), both graded on a scale of 0-4, were noted. After a mean of 3.8 ± 0.5 months (range 1-8 months) of AST treatment, pain severity decreased to 3.1 ± 0.3 (range 0-4), (p < 0.0001). Further, IVCM demonstrated a significant improvement (p < 0.005) in total nerve length (17,351.3 ± 1395.6 μm/mm2) and number (15.1 ± 1.6), as well as significant decrease in reflectivity (2.4 ± 0.2; p = 0.001) and tortuosity (2.2 ± 0.2; p = 0.001).
IVCM demonstrates underlying alterations of the subbasal corneal nerve plexus in patients suffering from debilitating NCP. AST-induced nerve regeneration is seen following treatment with AST, which correlates with improvement in patient symptoms of NCP.
This was a retrospective case-control study. Sixteen patients suffering from severe NCP and no current ocular surface disease were compared to 12 controls. In vivo confocal microscopy (IVCM) (HRT3/RCM; Heidelberg Engineering GmbH, Germany) of the central corneas was performed bilaterally. Change in pain severity (scale of 0-10), corneal nerve density, tortuosity, reflectivity and presence of beading and micro-neuromas before and after treatment were recorded.
All patients had severe pain, with a mean of 9.1 ± 0.2 (range 8-10). Subbasal nerves were significantly decreased before treatment as compared to controls, including total nerve length (10,935.5 ± 1264.3 vs. 24,714.4 ± 1056.2 μm/mm2; p < 0.0001) and total number of nerves (10.5 ± 1.4 vs. 28.6 ± 2.0; p < 0.0001), respectively. Morphologically, significantly increased reflectivity (2.9 ± 0.2 vs. 1.2 ± 0.1; p = 0.00008) and tortuosity (2.4 ± 0.2 vs. 1.7 ± 0.1; p = 0.001), both graded on a scale of 0-4, were noted. After a mean of 3.8 ± 0.5 months (range 1-8 months) of AST treatment, pain severity decreased to 3.1 ± 0.3 (range 0-4), (p < 0.0001). Further, IVCM demonstrated a significant improvement (p < 0.005) in total nerve length (17,351.3 ± 1395.6 μm/mm2) and number (15.1 ± 1.6), as well as significant decrease in reflectivity (2.4 ± 0.2; p = 0.001) and tortuosity (2.2 ± 0.2; p = 0.001).
IVCM demonstrates underlying alterations of the subbasal corneal nerve plexus in patients suffering from debilitating NCP. AST-induced nerve regeneration is seen following treatment with AST, which correlates with improvement in patient symptoms of NCP.
摘要：
角膜神经损伤可导致神经性角膜疼痛(NCP)。自体血清泪液（AST）已被证明可导致神经再生，并可能有助于减轻角膜疼痛。本研究旨在评价AST治疗NCP的疗效。
这是一项回顾性病例对照研究。将16例患有严重NCP且无当前眼表疾病的患者与12例对照进行比较。体内共聚焦显微镜（IVCM）（HRT3/RCM；海德堡工程有限公司，德国）的中央角膜是双侧进行的。疼痛严重程度的变化（0-10分），角膜神经密度，弯曲，记录治疗前后的反射率以及珠状和微神经瘤的存在。
所有患者都有剧烈疼痛,平均值为9.1±0.2（范围8-10）。与对照组相比，治疗前基底下神经明显减少，包括总神经长度（10,935.5±1264.3vs.24,714.4±1056.2μm/mm2；p<0.0001）和神经总数（10.5±1.4vs.28.6±2.0；p<0.0001)，分别。形态学上,反射率显著增加(2.9±0.2vs.1.2±0.1；p=0.00008）和弯曲度（2.4±0.2vs.1.7±0.1；p=0.001），两者均以0-4的等级进行分级。经过平均3.8±0.5个月（范围1-8个月）的AST治疗后，疼痛严重程度降低至3.1±0.3（范围0-4），（p<0.0001）。Further,IVCM显示出神经总长度（17,351.3±1395.6μm/mm2）和数量（15.1±1.6）的显着改善（p<0.005），以及反射率（2.4±0.2；p=0.001）和弯曲度（2.2±0.2；p=0.001）的显着降低。
IVCM显示患有衰弱性NCP的患者基底角膜下神经丛的潜在改变。AST诱导的神经再生在用AST治疗后可见，这与NCP患者症状的改善有关。
这是一项回顾性病例对照研究。将16例患有严重NCP且无当前眼表疾病的患者与12例对照进行比较。体内共聚焦显微镜（IVCM）（HRT3/RCM；海德堡工程有限公司，德国）的中央角膜是双侧进行的。疼痛严重程度的变化（0-10分），角膜神经密度，弯曲，记录治疗前后的反射率以及珠状和微神经瘤的存在。
所有患者都有剧烈疼痛,平均值为9.1±0.2（范围8-10）。与对照组相比，治疗前基底下神经明显减少，包括总神经长度（10,935.5±1264.3vs.24,714.4±1056.2μm/mm2；p<0.0001）和神经总数（10.5±1.4vs.28.6±2.0；p<0.0001)，分别。形态学上,反射率显著增加(2.9±0.2vs.1.2±0.1；p=0.00008）和弯曲度（2.4±0.2vs.1.7±0.1；p=0.001），两者均以0-4的等级进行分级。经过平均3.8±0.5个月（范围1-8个月）的AST治疗后，疼痛严重程度降低至3.1±0.3（范围0-4），（p<0.0001）。Further,IVCM显示出神经总长度（17,351.3±1395.6μm/mm2）和数量（15.1±1.6）的显着改善（p<0.005），以及反射率（2.4±0.2；p=0.001）和弯曲度（2.2±0.2；p=0.001）的显着降低。
IVCM显示患有衰弱性NCP的患者基底角膜下神经丛的潜在改变。AST诱导的神经再生在用AST治疗后可见，这与NCP患者症状的改善有关。
