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[摘要]
目的：通过观察中重度干眼患者使用0.05%环孢素(CsA)滴眼液(Ⅱ)治疗前后角膜上皮下神经(SBN)数量及形态的改变，探讨国产CsA对干眼的治疗效果和对SBN的影响。
方法：前瞻性研究。选取2020-12/2022-01来南昌大学附属眼科医院就诊的中重度干眼患者20例20眼，接受国产CsA治疗，完成3mo随访。分别于治疗前，治疗后3mo进行临床评估。观察临床症状、体征、SBN形态数量的变化。
结果：治疗3mo后，眼表疾病指数(OSDI)量表评分、TBUT、SchirmerⅠ、CFS均得到显著改善。共聚焦显微镜数据分析显示，治疗3mo后，SBN密度由13.49±5.43mm/mm2增加至14.93±5.34mm/mm2(P<0.001)，神经弯曲度评分由2.86±0.92分减少至2.31±0.75分(P<0.001)，串珠结构数量由1.45±0.67个/100微米减至1.07±0.45个/100微米(P<0.001)，树突细胞(DC)数量由5.83±3.28个/帧减少至3.67±2.24个/帧(P<0.001)。DC数量与分支神经数量、神经弯曲度评分、神经串珠结构数量呈正相关(rs=0.27，P=0.045； rs=0.407，P<0.01； rs=0.486，P<0.01)。
结论：神经损伤与干眼引起的角膜炎症相关，而0.05% CsA滴眼液(Ⅱ)能有效抑制炎症，改善SBN形态和数量； 通过共焦显微镜观察角膜SBN可以作为干眼治疗疗效评估的有效方法。
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[Abstract]
AIM:To investigate the efficacy of domestic cyclosporine A(CsA)in dry eye and its effect on sub-basal nerves(SBN)by observing quantitative and morphological changes in corneal SBN of patients with moderate to severe dry eye before and after the treatment with 0.05% CsA eye drops(Ⅱ).
METHODS: In this prospective study, a total of 20 patients(20 eyes)with moderate to severe dry eye who admitted to the ophthalmology department of the Affiliated Eye Hospital of Nanchang University from December 2020 to January 2022 were selected. They were treated with domestic CsA and followed up for 3mo. Clinical evaluation was carried out at baseline and at 3mo after treatment. The changes in clinical symptoms, signs and morphology and quantity of SBN were observed.
RESULTS: The ocular surface disease index(OSDI)score, the tear break-up time(TBUT), Schirmer Ⅰ, corneal fluorescein staining(CFS)score were significantly improved at 3mo after treatment. Confocal microscopy data analysis showed that SBN density increased from 13.49±5.43 mm/mm2 to 14.93±5.34 mm/mm2(P<0.001), nerve curvature scores decreased from 2.86±0.92 to 2.31±0.75(P<0.001), number of beaded structure decreased from 1.45±0.67/100μm to 1.07±0.45/100μm(P<0.001), and the number of dendritic cell(DC)decreased from 5.83±3.28 per frame to 3.67±2.24 per frame at 3mo after treatment(P<0.001). The number of DC was positively correlated with the number of branch nerves, the grade of nerve curvature and the number of nerve bead.(rs=0.27, P=0.045; rs=0.407, P<0.01; rs=0.486, P<0.01).
CONCLUSIONS: Nerve injury was positively correlated with corneal inflammation caused by dry eye, and 0.05%CsA eye drops(II)could effectively inhibit inflammation and improve the morphology and quantity of corneal SBN. Observation of corneal SBN via in vivo confocal microscopy can be used as an effective method to evaluate the therapeutic effect of dry eye patients.
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