糖尿病视网膜病变(DR)仍然是工作年龄人群失明的主要原因。它的进展导致角膜神经逐渐受损,导致角膜敏感性(CS)下降和前眼表稳态的破坏,临床表现为眼部不适和干眼病(DED)增加。这项研究包括52名DR患者和52名性别和年龄匹配的对照。眼表疾病指数(OSDI)调查,泪膜相关参数,CS,并进行了基底丛的体内角膜共聚焦显微镜(IVCM)。此外,所有患者均接受泪液取样进行神经营养因子和细胞因子分析.DR患者的OSDI评分高于对照组(p=0.00020)。Schirmer考试成绩没有差异,非侵入性泪膜破裂时间(NIBUT),泪液弯月面或干涉测量值,球根发红,发现眼睑炎或睑板腺丧失的严重程度。在DR组中,CS(p<0.001),暗视瞳孔直径(p=0.00008)减小。IVCM显示DR患者角膜神经参数降低。DR分期与OSDI呈正相关(Rs=+0.51,95%CI:+0.35-+0.64,p<0.001),与IVCM角膜神经参数和暗视瞳孔测量呈负相关(Rs=-0.26,95%CI:-0.44--0.06,p=0.0097)。我们发现OSDI和IVCM角膜神经支配参数之间呈负相关。DR组显示较低的泪膜-脑源性神经营养因子(BDNF)水平(p=0.0001),神经生长因子(NGF)-β无差异。神经营养因子(NT)-4,血管内皮生长因子(VEGF),白细胞介素(IL)-1β,IL-4、IL-5、IL-6或IL-12浓度。肿瘤坏死因子(TNF)-α,IL-2,IL-8,IL-10,粒细胞巨噬细胞集落刺激因子(GM-CSF),干扰素(IFN)-γ水平在DR患者中降低。角膜神经支配缺陷直接影响患者的主观感受。DR的演变似乎与角膜神经改变有关,强调IVCM的重要性。
Diabetic retinopathy (DR) remains the leading cause of blindness in the working-age population. Its progression causes gradual damage to corneal nerves, resulting in decreased corneal sensitivity (CS) and disruption of anterior-eye-surface homeostasis, which is clinically manifested by increased ocular discomfort and dry eye disease (DED). This study included 52 DR patients and 52 sex- and age-matched controls. Ocular Surface Disease Index (OSDI) survey, tear film-related parameters, CS, and in vivo corneal confocal microscopy (IVCM) of the subbasal plexus were performed. Furthermore, all patients underwent tear sampling for neurotrophin and cytokine analysis. OSDI scores were greater in DR patients than in controls (p = 0.00020). No differences in the Schirmer test score, noninvasive tear film-break-up time (NIBUT), tear meniscus or interferometry values, bulbar redness, severity of blepharitis or meibomian gland loss were found. In the DR group, both the CS (p < 0.001), and the scotopic pupil diameter (p = 0.00008) decreased. IVCM revealed reduced corneal nerve parameters in DR patients. The stage of DR was positively correlated with the OSDI (Rs = +0.51, 95% CI: + 0.35-+0.64, p < 0.001) and negatively correlated with IVCM corneal nerve parameters and scotopic pupillometry (Rs = -0.26, 95% CI: -0.44--0.06, p = 0.0097). We found negative correlations between the OSDI and IVCM corneal innervation parameters. The DR group showed lower tear film-brain-derived neurotrophic factor (BDNF) levels (p = 0.0001) and no differences in nerve growth factor (NGF)-β, neurotrophin (NT)-4, vascular endothelial growth factor (VEGF), interleukin (IL)-1β, IL-4, IL-5, IL-6, or IL-12 concentrations. Tumor necrosis factor (TNF)-α, IL-2, IL-8, IL-10, granulocyte macrophage colony-stimulating factor (GM-CSF), and interferon (IFN)-γ levels were decreased among patients with DR. Corneal innervation defects have a direct impact on patients\' subjective feelings. The evolution of DR appears to be associated with corneal nerve alterations, emphasizing the importance of IVCM.