目的:本研究的目的是使用体内共聚焦显微镜研究圆锥角膜患者交联前后的角膜微观结构和朗格汉斯细胞,并将形态学发现与临床和患者报告的结果相关联,包括眼睛摩擦(ER)行为。
方法:连续纳入接受离子电渗辅助上皮交联(I-CXL)的进行性圆锥角膜患者。在治疗前和治疗后6个月进行体内共聚焦显微镜检查。要求患者在视觉模拟量表(VAS)上量化其ER行为,并在同一时间点完成圆锥角膜结局研究问卷和眼表疾病指数问卷。视敏度,泪液渗透压,地形,像差测量,评估了双眼的测厚仪。
结果:这项初步研究包括13例患者。术前,平均朗格汉斯细胞密度为35,615个细胞/mm2,中位形态为3.治疗前的平均ERVAS为10分中的7,077。ERVAS与研究眼的朗格汉斯细胞密度和形态均呈显着正相关。治疗后,观察到ERVAS和朗格汉斯细胞变量的统计学显著降低.I-CXL术后6个月,平均基底丛神经密度与术前值相当。
结论:基于这一初步证据,圆锥角膜患者中央角膜中高密度成熟朗格汉斯细胞的存在及其与眼部摩擦的相关性支持炎症在圆锥角膜中的作用。治疗后这些标志物的减少可能表明CXL在中期缓解免疫相关炎症和眼部摩擦方面的潜力。
OBJECTIVE: The aim of this study was to investigate the corneal microstructure and Langerhans cells using in vivo confocal microscopy in keratoconus patients before and after cross-linking, and to correlate the morphologic findings with clinical and patient-reported outcomes, including eye rubbing (ER) behavior.
METHODS: Patients with progressive keratoconus undergoing iontophoresis-assisted epithelium-on cross-linking (I-CXL) were consecutively enrolled. In vivo confocal microscopy was performed before and 6 months after treatment. Patients were asked to quantify their ER behavior on a Visual Analogue Scale (VAS) and completed the Keratoconus Outcomes Research Questionnaire and the Ocular Surface Disease Index questionnaires at the same time points. Visual acuity, tear osmolarity, topography, aberrometry, and pachymetry of both eyes were assessed.
RESULTS: Thirteen patients were included in this pilot study. Preoperatively, the mean Langerhans cells density was 35,615 cells per mm2, and the median morphology was 3. The mean ER VAS before treatment was 7,077 out of 10. The ER VAS showed significant positive correlations with both Langerhans cells density and morphology of the study eye. After treatment, a statistically significant reduction in ER VAS and in Langerhans cells variables was observed. The mean sub-basal plexus nerve density was comparable to pre-operative values 6 months after I-CXL.
CONCLUSIONS: Based on this preliminary evidence, the presence of high density of mature Langerhans cells in the central cornea of keratoconus patients and its correlation with eye rubbing support the role of inflammation in keratoconus. The reduction in these markers after treatment may suggest a potential of CXL in moderating immune-related inflammation and eye rubbing in the medium term.