■研究局部自体血清泪液(AST)治疗后继发于眼带状疱疹(HZO)的严重神经营养性角膜病变(NK)患者的潜在角膜神经支配和角膜感觉恢复。
■对4例患有严重NK的HZO患者进行了临床随访,并进行了连续激光体内共聚焦显微镜检查(IVCM,HRT3/RCM,海德堡工程)在用20%AST治疗之前和期间每天下降八次。两名蒙面观察者查看了IVCM图像并评估了角膜神经改变。
■在基线时,所有患者角膜感觉完全丧失.此外,IVCM显示所有患者均完全缺乏基底角膜神经丛。所有四名患者对常规疗法均难以治疗,并接受AST滴剂治疗。所有患者在治疗3-7个月内通过IVCM表现出明显的神经再生。末次随访时,总神经密度增加至平均±SEM为10,085.88±2,542.74μm/mm2。通过Cochet-Bonnet美学测量法测量的角膜感觉改善至平均±SEM为3.50±1.30cm。有趣的是,4例患者中有3例在角膜神经支配后几周内发展为间质角膜炎伴溃疡,通过添加局部类固醇可以逆转。
■自体血清泪液可有效恢复继发于HZO的重度NK患者的角膜基底下神经和感觉。然而,这组患者在接受AST治疗时可能需要同时进行局部免疫调节和抗病毒治疗,以预防基质性角膜炎.
UNASSIGNED: To study potential corneal reinnervation and recovery of corneal sensation in patients with severe neurotrophic keratopathy (NK) secondary to herpes zoster ophthalmicus (HZO) after treatment with topical autologous serum tears (AST).
UNASSIGNED: Four cases of HZO with severe NK were followed clinically and by serial laser in vivo confocal microscopy (IVCM, HRT3/RCM, Heidelberg Engineering) before and during treatment with 20% AST drops eight times a day. Two masked observers reviewed the IVCM images and assessed corneal nerve alterations.
UNASSIGNED: At baseline, all patients had complete loss of corneal sensation. In addition, IVCM showed complete lack of the subbasal corneal nerve plexus in all patients. All four patients were refractory to conventional therapies and were treated with AST drops. All patients demonstrated significant nerve regeneration by IVCM within 3-7 months of treatment. The total nerve density increased to a mean ± SEM of 10,085.88±2,542.74 μm/mm2 at the last follow up. Corneal sensation measured by Cochet-Bonnet esthesiometry improved to a mean ± SEM of 3.50±1.30 cm. Interestingly, 3 of 4 patients developed stromal keratitis with ulceration within weeks of corneal reinnervation, which was reversed by adding topical steroids.
UNASSIGNED: Autologous serum tears are effective in restoring corneal subbasal nerves and sensation in patients with severe NK secondary to HZO. However, this group of patients may require concurrent topical immunomodulation and antiviral therapy while on AST to prevent stromal keratitis.