应用共聚焦显微镜观察有干眼症状软性角膜接触镜配戴者的角膜神经密度

目的 利用活体共聚焦显微镜分析软性角膜接触镜配戴者干眼症状的出现与角膜上皮下神经密度的相关性.方法 前瞻性临床研究.选择无症状软性角膜接触镜配戴者20例(40眼),有症状软性角膜接触镜配戴者20例(40眼)以及从未配戴软性角膜接触镜者17例(34眼,对照组).利用活体共焦显微镜分别拍摄角膜中央、颞侧及鼻侧上皮下神经密度.比较3组眼表疾病评分问卷(OSDI)得分、角膜荧光素染色评分、泪膜破裂时间(BUT)及Schirmer Ⅰ试验结果.采用单因素方差分析.结果 各组之间BUT( F=9.04,P＜0.01),角膜荧光素评分(F=3.21,P＜0.05)差异具有统计学意义.有症状软性角膜接触镜配戴组Schirmer Ⅰ试验结果较对照组小(P＜0.05).各组间不同方位角膜神经密度比较差异无统计学意义.各组内不同方位角膜神经密度比较,鼻侧与中央、颞侧相比较小,差异均有统计学意义(P＜0.05),中央与颞侧差异无统计学意义.结论 有症状软性角膜接触镜配戴者各项客观的干眼评价指标较未配戴软性角膜接触镜者高,与无症状者基本无差异.软性角膜接触镜配戴者干眼症状的出现不会影响角膜中央、颞侧及鼻侧的神经密度.角膜神经密度中央与颞侧基本无差异,而鼻侧小于中央及颞侧.

Observation of corneal nerve density for soft contact lens wearers with dry eye symptom using in vivo confcal microscopy

Objective To analyze the relationship between symptoms of dry eye and corneal subepithclial nerve density observed by in vivo confocal microscopy （IVCM）. Methods It was a prospective clinical study. Group 1 consisted of 20 soft contact lens （SCL） wearers （40 eyes） with serf-reported dryness. Group 2 consisted of 20 asymptomatic wearers （40 eyes）. Control group was composed of 17 non-lens wearers （34 eyes）. IVCM were used to get corneal subepithelial nerve density on the central cornea, the temporal side and nasal side. Ocular surface disease index （OSDI） dry eye questionnaire was given to each subject. The OSDI dry eye questionnaire score, corneal fluorescein staining score, tear film break up time （BUT） and Schirmer I test results were recorded. Data were analyzed with a one-way ANOVA. Results Significane differences among three groups were found in BUT （F=9.04, P〈0.01） and corneal fluorescein score （F=3.21, P〈0.05）. Schirmer I test result of group 2 was decreased compared with the control group （P〈0.05）. There were no significant differences of corneal nerve density in different directions among the groups. Corneal nerve density on the nasal cornea is statistically significant compared with the central and the temporal cornea （P〈0.05）. There was no significant difference in corneal nerve density between the central and the temporal cornea. Conclusion Objective dry eye assessment index of asymptomatic SCL wearers is increased compared with the non-lens wearers, but no difference between symptomatic SCL wearers and with self-reported dryness SCL wearers is found. The dry eye symptoms in SCL wearers are not associated with corneal nerve density. Corneal nerve density of the nasal cornea is less than either the central or the temporal cornea, but there is no significant difference between the central and thetemporal cornea.