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Abstract：
To evaluate corneal subbasal nerve plexus by in vivo confocal microscopy (IVCM) following punctal occlusion in patients with moderate to severe dry eye disease (DED).
Patients with grade 3 or 4 severity of DED based on Delphi Panel dry eye severity grading scheme were enrolled in the study. Permanent inferior punctal occlusion was performed. A comprehensive ophthalmic evaluation, including Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal fluorescein staining, conjunctival Rose bengal staining, Schirmer\'s test, and corneal sensation by Cochet-Bonnet esthesiometry, were performed at baseline, and 1 and 3 months after punctal occlusion. Furthermore, density and number of corneal subbasal nerves were evaluated by IVCM.
Forty-one eyes of 23 patients with a mean age of 46.3 ± 9.0 years were enrolled. Corneal fluorescein staining, Rose bengal staining, and TBUT significantly improved at 3 months following punctal occlusion (p < .015). Corneal esthesiometry significantly increased at both postoperative visits (p < .03), and OSDI scores improved only at 3-month follow-up (p < .005). Nerve density and total number significantly increased 3 months after punctal occlusion (p < .045). Baseline nerve density had significant correlations with TBUT, fluorescein staining, Rose bengal staining (p < .012), but not with esthesiometry, Schirmer scores, or OSDI scores (p > .329).
Corneal subbasal nerve density and total number increased following punctal occlusion in patients with moderate to severe DED. These findings were associated with improvements in corneal sensation, and signs and symptoms of DED. This emphasizes the effect of punctal occlusion in regeneration of corneal subbasal nerve plexus.
Patients with grade 3 or 4 severity of DED based on Delphi Panel dry eye severity grading scheme were enrolled in the study. Permanent inferior punctal occlusion was performed. A comprehensive ophthalmic evaluation, including Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal fluorescein staining, conjunctival Rose bengal staining, Schirmer\'s test, and corneal sensation by Cochet-Bonnet esthesiometry, were performed at baseline, and 1 and 3 months after punctal occlusion. Furthermore, density and number of corneal subbasal nerves were evaluated by IVCM.
Forty-one eyes of 23 patients with a mean age of 46.3 ± 9.0 years were enrolled. Corneal fluorescein staining, Rose bengal staining, and TBUT significantly improved at 3 months following punctal occlusion (p < .015). Corneal esthesiometry significantly increased at both postoperative visits (p < .03), and OSDI scores improved only at 3-month follow-up (p < .005). Nerve density and total number significantly increased 3 months after punctal occlusion (p < .045). Baseline nerve density had significant correlations with TBUT, fluorescein staining, Rose bengal staining (p < .012), but not with esthesiometry, Schirmer scores, or OSDI scores (p > .329).
Corneal subbasal nerve density and total number increased following punctal occlusion in patients with moderate to severe DED. These findings were associated with improvements in corneal sensation, and signs and symptoms of DED. This emphasizes the effect of punctal occlusion in regeneration of corneal subbasal nerve plexus.
摘要：
目的通过体内共聚焦显微镜（IVCM）评估中度至重度干眼症（DED）患者泪点阻塞后的角膜基底下神经丛。
根据DelphiPanel干眼严重程度分级方案，DED严重程度为3级或4级的患者纳入研究。进行永久性下泪点闭塞。全面的眼科评估，包括眼表疾病指数(OSDI)问卷，泪液破裂时间(TBUT),角膜荧光素染色，结膜玫瑰红染色，Schirmer\'stest,和角膜感觉通过Cochet-Bonnet美学测量法，在基线时进行，泪点闭塞后1个月和3个月。此外，通过IVCM评估角膜基底下神经的密度和数量。
纳入23例患者41只眼，平均年龄46.3±9.0岁。角膜荧光素染色,玫瑰红染色,泪点闭塞后3个月，TBUT显着改善（p<.015）。角膜美学测量在术后两次就诊时显著增加(p<.03)，OSDI评分仅在3个月随访时有所改善（p<0.005）。泪点闭塞后3个月神经密度和总数显著增加(p<.045)。基线神经密度与TBUT有显著相关性,荧光素染色,玫瑰红染色（p<.012），但不是用美学测量法，Schirmer得分,或OSDI分数（p>.329）。
中度至重度DED患者泪点闭塞后角膜基底下神经密度和总数增加。这些发现与角膜感觉的改善有关，以及DED的症状和体征。这强调了泪点闭塞在角膜基底下神经丛再生中的作用。
根据DelphiPanel干眼严重程度分级方案，DED严重程度为3级或4级的患者纳入研究。进行永久性下泪点闭塞。全面的眼科评估，包括眼表疾病指数(OSDI)问卷，泪液破裂时间(TBUT),角膜荧光素染色，结膜玫瑰红染色，Schirmer\'stest,和角膜感觉通过Cochet-Bonnet美学测量法，在基线时进行，泪点闭塞后1个月和3个月。此外，通过IVCM评估角膜基底下神经的密度和数量。
纳入23例患者41只眼，平均年龄46.3±9.0岁。角膜荧光素染色,玫瑰红染色,泪点闭塞后3个月，TBUT显着改善（p<.015）。角膜美学测量在术后两次就诊时显著增加(p<.03)，OSDI评分仅在3个月随访时有所改善（p<0.005）。泪点闭塞后3个月神经密度和总数显著增加(p<.045)。基线神经密度与TBUT有显著相关性,荧光素染色,玫瑰红染色（p<.012），但不是用美学测量法，Schirmer得分,或OSDI分数（p>.329）。
中度至重度DED患者泪点闭塞后角膜基底下神经密度和总数增加。这些发现与角膜感觉的改善有关，以及DED的症状和体征。这强调了泪点闭塞在角膜基底下神经丛再生中的作用。
