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Zhu XY, Ge QS, Li ZY, Zhou LF, Bu QW, Su Y, Wang XJ, Zhou QJ, Pan XJ, Hu D. Corneal nerve changes by anti-glaucoma medications examined by in vivo confocal microscopy. Int J Ophthalmol 2024; 17:1645-1653. [PMID: 39296575 PMCID: PMC11367442 DOI: 10.18240/ijo.2024.09.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/21/2024] [Indexed: 09/21/2024] Open
Abstract
AIM To evaluate the effects of antiglaucoma eye drops on corneal nerves by in vivo confocal microscopy (IVCM). METHODS This study comprised 79 patients diagnosed with glaucoma and 16 healthy control individuals. Among the glaucoma patients, 54 were treated with medication, while 25 remained untreated. Central corneal images were evaluated by IVCM, and then ACCMetrics was used to calculate the following parameters: corneal nerve fiber density (CNFD), branch density (CNBD), fiber length (CNFL), total branch density (CTBD), fiber area (CNFA), fiber width (CNFW), and fractal dimension (CNFrD). The correlation between IVCM parameters and drugs was evaluated using non-parametric measurements of Spearman's rank correlation coefficient. RESULTS The CNFD was reduced in glaucoma groups compared to healthy subjects (P<0.01). Patients using anti-glaucoma medications exhibited poorer confocal parameters compared to untreated patients. As the number of medications and usage count increased, CNFD, CNBD, CNFL, CTBD, CNFA, and CNFrD experienced a decline, while CNFW increased (all P<0.01). For the brinzolamide-therapy group, there was a significant decrease in CNFD and CNFL compared to the other monotherapy groups (P<0.001). In the absence of medication, CNFD in males was lower than that in females (P<0.05). Among patients under medication therapy, CNFD remained consistent between males and females. CONCLUSION Antiglaucoma eye drops affect the microstructure of corneal nerves. IVCM and ACCMetrics are useful tools that could be used to evaluate the corneal nerve changes.
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Affiliation(s)
- Xin-Yuan Zhu
- School of Clinical Medicine, Shandong Second Medical University, Weifang 261053, Shandong Province, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Qing-Shu Ge
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Zong-Yi Li
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Long-Fang Zhou
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Qian-Wen Bu
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Ying Su
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Xin-Jie Wang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Qing-Jun Zhou
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Xiao-Jing Pan
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Die Hu
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao 266071, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266071, Shandong Province, China
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Chin JY, Liu C, Lee IXY, Lin MTY, Cheng CY, Wong JHF, Teo CL, Mehta JS, Liu YC. Impact of Age on the Characteristics of Corneal Nerves and Corneal Epithelial Cells in Healthy Adults. Cornea 2024; 43:409-418. [PMID: 37643477 PMCID: PMC10906190 DOI: 10.1097/ico.0000000000003363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/26/2023] [Accepted: 07/02/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The aim of this study was to investigate age-related changes in corneal nerves and corneal epithelial cell parameters and to establish age-adjusted reference values. METHODS A total of 7025 corneal nerve images and 4215 corneal epithelial images obtained using in vivo confocal microscopy from 281 eyes of 143 healthy participants were included. Seven corneal nerve parameters and 3 corneal epithelial cell parameters were quantified using 2 automatic analytic software and analyzed across 6 age groups ranging from 21 to 80 years. RESULTS There was a declining trend in all 7 nerve parameters with advancing age. In particular, corneal nerve fiber length and corneal nerve fiber density demonstrated a significant decrease in subjects aged 65 years or older compared with subjects younger than 65 years (10.8 ± 2.6 mm/mm 2 vs. 9.9 ± 2.0 mm/mm 2 , P = 0.011 in corneal nerve fiber length; 15.8 ± 5.2 fibers/mm 2 vs. 14.4 ± 4.3 fibers/mm 2 , P = 0.046 in corneal nerve fiber density), whereas corneal nerve fractal dimension demonstrated a borderline significant decrease ( P = 0.057). Similarly, there was a general declining trend in all epithelial cell parameters with advancing age. Corneal epithelial cell circularity was significantly lower in subjects aged 65 years and older as compared to subjects younger than 65 years (0.722 ± 0.021 μm 2 vs. 0.714 ± 0.021 μm 2 ; P = 0.011). CONCLUSIONS Advancing age results in reduced corneal nerve metrics and alteration of corneal cell morphology. Aging effects should be considered when evaluating patients with corneal neuropathy.
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Affiliation(s)
- Jia Ying Chin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Chang Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Isabelle Xin Yu Lee
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Molly Tzu Yu Lin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Ching-Yu Cheng
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Epidemiology Group, Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jipson Hon Fai Wong
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Cong Ling Teo
- Epidemiology Group, Singapore Eye Research Institute, Singapore
| | - Jodhbir S. Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; and
| | - Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; and
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Akkul Z, Erkilic K, Sener H, Polat OA, Er Arslantas E. Diabetic corneal neuropathy and its relation to the severity of retinopathy in patients with type 2 diabetes mellitus: an in vivo confocal microscopy study. Int Ophthalmol 2024; 44:108. [PMID: 38386121 DOI: 10.1007/s10792-024-03043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To investigate corneal neuropathy and corneal nerve alterations in type 2 diabetes mellitus (DM) patients with different diabetic retinopathy (DR) status. METHODS A total of 87 eyes of 87 patients with DM and 28 eyes of 28 healthy control subjects were included in the study. DM patients were further classified into 3 groups: patients without DR (NDR), patients with non-proliferative DR (NPDR), and patients with proliferative DR (PDR). PDR patients were classified into 2 groups regarding having undergone retinal argon laser photocoagulation treatment (ALP). Ocular surface disease index score (OSDI), average tear break-up time (A-BUT), corneal sensitivity and cornea nerve fiber length (CNFL), cornea nerve fiber density (CNFD), and cornea nerve branch density (CNBD) of the cornea subbasal nerve plexus (SBNP) were measured using in vivo confocal microscopy (IVCM). RESULTS OSDI scores increased and A-BUT decreased in DM patients compared to the control group, but no significant difference was found between DM patient groups. Corneal sensitivity decreased in DM patients who developed DR, compared to both the controls and the NDR group. CNFD and CNFL decreased in NPDR and PDR patients compared to controls. CNFD and CNBD decreased in patients who had developed PDR, compared to all three groups. All IVCM parameters decreased with DR progression. CONCLUSION IVCM can detect early structural corneal nerve changes in diabetic patients. The presence of DM affects ocular surface parameters, especially in long-term DM patients. Corneal sensitivity loss is increased with the presence of DR. All IVCM parameters decrease with DR development and its progression.
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Affiliation(s)
- Zeynep Akkul
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey.
| | - Kuddusi Erkilic
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hidayet Sener
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Osman Ahmet Polat
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Elif Er Arslantas
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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Zhang C, Zhu L, Liang X, Li Y, Sun G, Hu J, Zhang H. Corneal characteristics of Mongolian population with type 2 diabetic peripheral neuropathy in inner Mongolia, China: an assessment using corneal confocal microscopy. BMC Ophthalmol 2023; 23:460. [PMID: 37968622 PMCID: PMC10652475 DOI: 10.1186/s12886-023-03181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/20/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE To quantify corneal nerve fiber parameters in a Mongolian population with diabetic peripheral neuropathy (DPN) by corneal confocal microscopy. METHODS This study conducted a comprehensive evaluation of 114 participants from Hulunbuir between January 2020 and December 2021. The participants included healthy controls, Mongolian and Han patients with type 2 diabetes mellitus. Demographic, medical, and laboratory data were collected, and neuropathy was evaluated by confocal corneal microscopy. And compare various parameters between Han and Mongolian were performed using SPSS software. RESULTS The average waist circumference of Mongolian diabetic patients was larger than that of Han diabetic patients (P < 0.05). The mean HbA1c of Mongolian was 9.30 (8.15, 10.30) %, and that of Han was 8.30 (7.20, 9.40) % (P = 0.023). The average values of Corneal Nerve Fiber Density (CNFD), Corneal Nerve Fiber Length (CNFL) and corneal nerve branch density (CNBD) in Mongolian diabetic patients were significantly lower than those in Han diabetic patients (P < 0.05). The correlation coefficient between CNFL and age was - 0.368. ROC results show that CNBD has a certain diagnostic value for DPN in Mongolian patients with type 2 diabetes and the optimal cut-off point value is 24.99(no./mm2), the sensitivity is 80.0%, and the specificity is 77.8%. CONCLUSION The corneal confocal microscopy could possibly represent a promising adjuvant technique for the early diagnosis and assessment of PDN in Mongolian T2DM patients.
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Affiliation(s)
- Chi Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, 1055 San-Xiang Road, Suzhou, 215000, China
- Department of Endocrinology, Hulunbeir People's Hospital, Hulunbuir, China
| | - Lei Zhu
- Department of Orthopedics, Hulunbeir People's Hospital, Hulunbuir, China
| | - Xiuwen Liang
- Department of Cardiology, Hulunbuir Zhong Meng Hospital, Hulunbuir, China
| | - Yue Li
- Department of Ophthalmology, Hulunbeir People's Hospital, Hulunbuir, China
| | - Guotong Sun
- Department of Cardiology, Shouguang Hospital of T.C.M, Weifang, China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, 1055 San-Xiang Road, Suzhou, 215000, China.
| | - Honghong Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, 1055 San-Xiang Road, Suzhou, 215000, China.
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Morphological alterations in corneal nerves of patients with dry eye and associated biomarkers. Exp Eye Res 2023; 230:109438. [PMID: 36933693 DOI: 10.1016/j.exer.2023.109438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
The purposes of the present study were to (1) identify the relationship between dry eye symptoms and morphological changes in corneal subbasal nerves/ocular surfaces, and (2) discover tear film biomarkers indicating morphological changes in the subbasal nerves. This was a prospective cross-sectional study conducted between October and November 2017. Adults with dry eye disease (DED, n = 43) and healthy eyes (n = 16) were evaluated based on their subjective symptoms and ophthalmological findings. Corneal subbasal nerves were observed using confocal laser scanning microscopy. Nerve lengths, densities, branch numbers, and nerve fiber tortuosity were analyzed using ACCMetrics and CCMetrics image analysis systems; tear proteins were quantified by mass spectroscopy. Compared with the control group, the DED group had significantly lower tear breakup times (TBUT) and pain tolerance capacity, and significantly higher corneal nerve branch density (CNBD) and corneal nerve total branch density (CTBD). CNBD and CTBD showed significant negative correlations with TBUT. Six biomarkers (cystatin-S, immunoglobulin kappa constant, neutrophil gelatinase-associated lipocalin, profilin-1, protein S100-A8, and protein S100-A9) showed significant positive correlations with CNBD and CTBD. The significantly higher CNBD and CTBD in the DED group suggests that DED is associated with morphological alterations in corneal nerves. The correlation of TBUT with CNBD and CTBD further supports this inference. Six candidate biomarkers that correlate with morphological changes were identified. Thus, morphological changes in corneal nerves are a hallmark of DED, and confocal microscopy may help in the diagnosis and treatment of dry eyes.
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