| Objective:To quantitatively analyze the corneal epithelial basal plexus in patients with different degrees of dry eye and to explore its changes.Methods:Cross sectional study.A total of 91 eyes of dry eye patients(n=91)with mild dry eye(n=34),moderate dry eye(n=33),and severe dry eye(n=24)were recruited from the outpatient clinic of Shanxi Eye Hospital between April 2021 and October 2021.A total of27 eyes(n=27)were recruited from normal healthy volunteers as the control group,and all subjects were selected for right eye data analysis.After routine ophthalmic examination,comprehensive ocular surface analyzer examination,and confocal microscopy of the cornea were performed for all subjects,the structural puzzle of the large corneal epithelial basal nerve plexus(SNP)was synthesized using Photoshop CC2018 and captured as a vortex structure centered at 700μm×700μm of the images were analyzed,combined with the calculation of the total length of nerve fibers(NFL)in the images by the image J.The resulting data were converted from the image size to pixels to calculate the total length of nerve fibers per unit area(1mm~2),which was the value of nerve fiber density(mm/mm~2).One way ANOVA was used to statistically compare the data in each group,while pairwise comparisons were made between the means of each group(LSD multiple comparisons),and Pearson’s linear correlation was used to analyze the correlation between corneal nerve fiber density in each group and each index in the comprehensive analysis examination of the ocular surface.Results:1.In the control group,the corneal SNP nerve fibers were generally thin,occasionally with thick trunk,straight and regular course,small curvature and rare nerve branches.In patients with mild to moderate dry eyes,the corneal SNP nerve fibers are generally thickened,the nerve branches are significantly increased,the shape is tortuous,the original parallel and smooth spiral shape is lost,and more Langhans cell infiltration can be seen.In patients with severe dry eye,nerve fibers are rarely seen even under confocal microscope.The continuity of corneal nerve is interrupted,some nerves become short rods,the curvature is also relatively reduced,and a large number of Langhans cell infiltration can be seen.2.In the control group,nerve fiber density was(22.71±6.19)mm/mm~2,Mild dry eye group was(28.58±5.19)mm/mm~2,Moderate dry eye group was(28.17±4.71)mm/mm~2,and Severe dry eye group was(5.98±7.32)mm/mm~2,corneal SNP density was significantly different between groups(F=88.102,P<0.001).3.The density of SNP in the control group was significantly different from that in the mild,moderate,and severe dry eye groups(P<0.001),that in the mild dry eye group was not significantly different from that in the moderate dry eye group(P=0.777),and that in the mild,moderate dry eye group was significantly different from that in the severe dry eye group(P<0.001).4.There were no significant correlations between corneal SNP density and tear meniscus height(TMH)(r=0.140,P=0.186),meibomian gland missing area score(superior+inferior)(r=-0.128,P=0.228)or ocular surface hyperemia score(r=-0.143,P=0.175)in patients with dry eye,which was positive correlation with noninvasive breakup time(NIBUT)(r=0.509,P<0.001),It was negatively correlated with the grade of lipid layer(r=-0.302,P=0.004)and the grade of corneal fluorescein sodium staining(r=-0.678,P<0.001).5.Conclusion:1.The morphology of corneal epithelium and basal plexus in patients with dry eye has changed significantly,which can be used as one of the auxiliary diagnostic methods of clinical dry eye.2.The density of corneal epithelial basal plexus in patients with dry eye changes significantly,which is related to the severity of dry eye,and can be used as an effective index for clinical diagnosis and evaluation of dry eye.3.The stability of tear film in patients with dry eye is positively correlated with the density of corneal epithelial basal plexus,which may provide ideas for the neurotrophic treatment of dry eye. |
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