三叉神经痛患者眼表表现及角膜神经的共焦显微镜观察

背景三叉神经眼支是角膜的主要感觉神经和营养神经，三叉神经痛是否会影响患侧眼角膜的功能和形态尚未见报道。共焦显微镜是角膜无创性活体检测的主要手段。目的观察和分析三叉神经痛患者角膜的共焦显微镜下表现及角膜神经在共焦显微镜下形态和密度的改变。方法收集就诊于河南省人民医院疼痛科的33例三叉神经痛患者，对所有受检眼应用角膜知觉敏感度测量计测定角膜知觉，并进行泪液分泌功能测定、泪膜破裂时间（BUT）测定和共焦显微镜观察，对侧眼作为对照组。结果三叉神经痛组角膜知觉测试的纤维长度为（54．348±6．793）mm，正常对照组的角膜知觉平均值为（55．217±6．480）him，差异无统计学意义（t=0．641，P=0．528）；三叉神经痛组SchiemerI试验的滤纸浸湿长度平均值为（9．390±6．583）mm，正常对照组为（9．300±5．295）mm，差异无统计学意义（t=0．070，P=0．945）；2组的BUT平均值分别为（6．09±4．177）S和（6．13±4．799）s，差异无统计学意义（t=-0．085，P=0．933）。角膜鼻侧、颞侧、上方、下方和中央区上皮下神经丛密度与对照组比较，差异均无统计学意义（P=0．840、0．459、0．268、0．120、0．607）。共焦显微镜下三叉神经痛组角膜上皮下神经丛神经纤维数量减少、扭曲；角膜基质中神经丛纤细、盘旋、弯曲；正常对照组上皮下神经纤维分布较密集，平行分布；角膜基质中神经纤维笔直走行，较上皮下神经纤维粗大且分支较多。结论共焦显微镜结果显示三叉神经痛患者患侧眼较正常眼角膜神经扭曲，但眼表功能和角膜神经密度计数无明显改变。

Ocular surface findings and corneal nerve changes under confocal microscopy in patients with trigeminal neuralgia

Background The ocular nerve of trigeminus is the sensation and nutrition nerve of cornea.Whether trigeminal neuralgia affect the function of ocular surface and the morphology of corneal nerve plexus or not is below understanding.Confocal microscope is a non-invasive method for in vivo corneal examination.Objective This study was to analyze the ocular surface findings and observe the morphology and density of corneal nerve under the confocal microscopy in patients with trigeminal neuralgia.Methods Thirty-three eyes of 33 patients with trigeminal neuralgia were collected from the Department of Pain Management in Henan Provincial People's Hospital.The corneal perceptual sensitivity was examined using corneal aesthesiometer,and the function of lacrimal secretion (Schiemer Ⅰtest),tear break-up time (BUT) were performed to evaluate the influence of trigeminal neuralgia on ocular surface.The change of corneal nerve was observed under the confocal microscopy.The fellow eyes served as controls.The informed consent was obtained from the subjects before any examination.Results The fiber length of corneal perceptual sensitivity was (54.348±6.793)mm and (55.217±6.480)mm in trigeminal neuralgia group and control group without a significant difference between them (t=0.641,P=0.528).No significant differences were found in the mean value of Schiemer Ⅰtest (9.390±6.583mm vs 9.300±5.295mm) and BUT result (6.09±4.177s vs 6.13±4.799s) between trigeminal neuralgia and control group(t=0.070,P=0.945;t=-0.085,P=0.933).The densities value of corneal subepithelial nerve plexus at the nasal,temporal,superior,inferior and central area was insignificantly changed between trigeminal neuralgia group and control group(P=0.840,0.459,0.268,0.120,0.607).Tenuous,bending and circling nerve fibers were seen in corneal stroma under the confocal microscope,while the nerve fibers were strict in controls.Conclusion Trigeminal neuralgia does not dramatically affect eye surface function and corneal subbasal nerve plexus density,but corneal nerve fibers with trigeminal neuralgia are more bending than normal people.