背景:干眼综合征(DES)是一种常见的疾病,临床表现多样。DES与糖尿病有显著关联。闪烁反射(BR)也称为三叉神经面部反射。角膜神经的刺激是BR刺激的起源之一。通过面神经发出的副交感神经纤维是眼泪反射的出口。BR可用于评估角膜神经闭环的功能;然而,这些患者的BR变化是否尚不清楚.
目的:了解有无糖尿病干眼症患者角膜神经的形态和功能。
方法:本研究纳入了131名患者,他们在2019年1月至2020年8月期间就诊于眼科和内分泌科的住院和门诊,主观症状为干眼和非干眼原因,以及同事等志愿者。患者分为四组:DEwDM,患有2型糖尿病(T2DM)的干眼症;DMnDE,T2DM无干眼症;DEnDM,没有糖尿病的干眼症;和nDMnDE,既没有干眼也没有糖尿病。泪膜破裂的时间,Schirmer我测试,体内共聚焦显微镜,进行了BR。
结果:DEwDM,DMnDE,DEnDM,nDMnDE组包括56、22、33和20名患者,分别。四组之间的性别和年龄差异无统计学意义。DEwDM患者的神经纤维长度(NFL),DEnDM,DMnDE组降低(P<0.001,P=0.014,P=0.001)。四组间角膜神经纤维密度(NFD)(P=0.083)和角膜神经支密度(NBD)(P=0.195)差异无统计学意义。与DMnDE组相比,闪烁反射的R1延迟仅在DEwDM组中增加(P=0.008,P=0.001,P<0.001,P<0.001,DEnDM,和nDMnDE组,分别)。在中度和重度干眼患者中,DEwDM和DEnDM组之间的NBD和R1潜伏期不同。
结论:干眼或糖尿病患者角膜神经形态改变,或者两者兼而有之,而角膜神经闭环功能仅在干眼症和糖尿病患者中降低。
BACKGROUND: Dry eye syndrome (DES) is a common disease with various clinical manifestations. DES had a significant association with diabetes. Blink reflex (BR) is also known as trigeminal nerve facial reflex. The stimulation of corneal nerves is one of the origins of BR stimulation. The parasympathetic fibers sent out through the facial nerve are the outlet of tear reflexes. BR can be used to assess the function of the corneal nerve closed-loop; however, whether the BR changes in these patients is unclear.
OBJECTIVE: To understand the morphology and function of the corneal nerve in patients with dry eyes having diabetes or not.
METHODS: This study enrolled 131 patients who visited the inpatient and outpatient services of ophthalmology and endocrinology departments between January 2019 to August 2020 with subjective symptoms of dry eyes and non-dry eye reasons, as well as volunteers such as colleagues. The patients were divided into four groups: DEwDM, with dry eyes having type 2 diabetes mellitus (T2DM); DMnDE, with T2DM not having dry eyes; DEnDM, with dry eyes not having diabetes; and nDMnDE, with neither dry eyes nor diabetes. The tear film break-up time, Schirmer I test, in vivo confocal microscopy, and BR were performed.
RESULTS: The DEwDM, DMnDE, DEnDM, and nDMnDE groups included 56, 22, 33, and 20 patients, respectively. Sex and age were not statistically different among the four groups. The nerve fiber length (NFL) of patients in the DEwDM, DEnDM, and DMnDE groups reduced (P < 0.001, P = 0.014, and P = 0.001, respectively). No significant difference in corneal nerve fiber density (NFD) (P = 0.083) and corneal nerve branch density (NBD) (P = 0.195) was found among the four groups. The R1 Latency of blink reflexes increased only in the DEwDM group (P = 0.008, P = 0.001, P < 0.001, compared with the DMnDE, DEnDM, and nDMnDE groups, respectively). The NBD and R1 Latency were different between DEwDM and DEnDM groups in patients with moderate and severe dry eyes.
CONCLUSIONS: The corneal nerve morphology changed in patients with dry eyes or diabetes, or with both, while the function of corneal nerve closed-loop reduced only in those with dry eyes and diabetes.