目的:分析和量化神经外科手术后三叉神经损伤致单侧神经营养性角膜炎(NK)患者的眼表参数。
方法:该研究包括26名接受过神经外科手术的单侧NK患者,和20个匹配的正常对照。收集并分析所有参与者的人口统计学和临床特征。裂隙灯检查,Cochet-Bonnet美学测量法,角膜描记器5米,对17例轻度NK患者的双眼进行了LipiView干涉仪。对于9名中度/重度NK患者,通过体内共聚焦显微镜测量基底下神经密度。
结果:在26例患者中,九人有听神经瘤,九人患有三叉神经痛,八个人患有肿瘤。在17只轻度NK眼中的一只(5.9%)和9只中度/重度NK眼中的七只(77.8%)中观察到面神经麻痹。与对侧和正常对照眼相比,26只NK眼在5个角膜区域的敏感性明显降低(P<0.05)。中重度NK眼的角膜敏感性明显低于轻度NK眼(P<0.05)。中度/重度NK眼视力不佳,基底下神经密度低于对照组。中度/重度NK的发病时间为0.5至24个月(中位数[Q1,Q3],1[0.5,2.5]个月)神经外科手术后。对于温和的NK眼睛来说,总眨眼次数,首次无创泪液破裂时间(NITBUT)和平均NITBUT明显低于对侧和正常对照眼(P<0.05),部分眨眼次数和部分眨眼率均明显高于其他两个对照组(P<0.05)。
结论:神经外科手术后三叉神经损伤引起的NK患者角膜敏感性不同程度降低,伴有部分眨眼增加和NITBUT缩短。NK的严重程度与角膜感觉障碍的严重程度有关。面神经麻痹可加重NK的临床进展。试验注册中国临床试验注册中心(ChiCTR2100044068,注册日期:2021年3月9日)。
OBJECTIVE: To analyse and quantify ocular surface parameters in patients with unilateral neurotrophic keratitis (NK) induced by trigeminal nerve injury post-neurosurgery.
METHODS: The study included 26 unilateral NK patients who had undergone neurosurgery, and 20 matched normal controls. Demographic and clinical characteristics of all participants were collected and analysed. Slit-lamp examination, Cochet-Bonnet aesthesiometry, Keratograph 5 M, and LipiView interferometer were performed on both eyes of 17 mild NK patients. For nine moderate/severe NK patients, sub-basal nerve density was measured by in vivo confocal microscopy.
RESULTS: Of the 26 patients, nine had acoustic neuroma, nine had trigeminal neuralgia, and eight had neoplasms. Facial nerve paralysis was observed in one of the 17 mild NK eyes (5.9%) and seven of the nine moderate/severe NK eyes (77.8%). Compared to contralateral and normal control eyes, 26 NK eyes showed significantly reduced sensitivity in five corneal regions (P < 0.05). Corneal sensitivity in moderate/severe NK eyes was significantly lower than in mild NK eyes (P < 0.05). Moderate/severe NK eyes had poor visual acuity, and their sub-basal nerve density was lower than that of the controls. The onset of the moderate/severe NK was from 0.5 to 24 months (median [Q1, Q3], 1 [0.5, 2.5] months) after neurosurgery. For the mild NK eyes, the number of total blinks, the first non-invasive tear breakup time (NITBUT) and average NITBUT were significantly lower than contralateral and normal control eyes (P < 0.05), and the number of partial blinks and partial blinking rate were significantly higher than the other two control groups (P < 0.05).
CONCLUSIONS: Patients with NK induced by trigeminal nerve injury following neurosurgery had decreased corneal sensitivity to various degrees accompanied by increased partial blinks and shortened NITBUT. The severity of NK is related to the severity of the corneal sensory impairment. Facial nerve paralysis can worsen the clinical progression of NK. Trial registration Chinese Clinical Trial Registry (ChiCTR2100044068, Date of Registration: March 9, 2021).