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.
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。