Objective To evaluate morphological changes of corneal subbasal nerve plexus in patients with ocular blunt trauma using in vivo confocal microscope.Methods A prospective study.Twentythree consec utive zone 2 or zone 3 monoc ular contusion outpatients from the same ophthalmologist in the Affiliated Eye Hospital of Wenzhou Medical College were included in this study from December 2009 to December 2010.The 23 injured eyes divided into trauma group,and the contralateral 23 normal eyes were divided into control group.In vivo confocal microscope (1VCM) was performed in both groups at the first week after injury,and in trauma group at the first and the third month after injury.The main parameters for analyzing were corneal subbasal nerve plexus density,nerve trunks,nerve branching,total nerve number,and nerve tortuosity.Data were analyzed using a paired t-test and Wilcoxon signed-rank test to compare the difference of parameters between the control group and each time point of trauma group.A repeated measures analysis of variance (ANOVA) was used to analyze data on the three time points in the trauma group.Results All parameters of trauma group were changed significantly over time (F values:16.272,24.138,63.393,68.122,91.463,all P values ＜ 0.01).Corneal subbasal nerve plexus density,nerve trunks,nerve branching,total nerve number were significantly decreased at the first week [(624.0 ±109.9) μm/frame,1.66 line/frame,6.70 line/frame,8.45 line/frame)] compared with control group [(1677.9 ± 87.1) μm/frame,4.80 line/frame,8.98 line/frame,13.80 line/frame) (t =8.998,9.301,9.119,12.969 ; all P ＜ 0.01)],and showed a continued downward trend with time.However,nerve trunk showed no significant changes at the first week (1.66 line/frame) and the first month (2.31 line/frame) (t =-1.518; P =0.143).Nerve tortuosity was significantly increased at the first week (1.66) compared with control group (1.00) (t =-6.879 ; P ＜ 0.01),and then kept increasing gradually.At the first month after injury,the nerve tortuosity (3.20) was more obvious than the first week (P ＜ 0.01),and nerve regeneration could be observed.At the third month,the values of each parameters were gradually approaching levels of control group.Nerve trunks (4.00 line/frame),nerve branching (8.69 line/frame),total nerve number (13.26 line/frame) and nerve tortuosity (1.00) of trauma group showed no significant difference compared with control group (t =3.117,1.703,3.325,-1.837 ; P =0.079,0.792,0.392,0.392),but nerve density [(1064.3 ±93.3) μm/frame] was still less than control group(t =5.736; P ＜0.01).Injury of different zone showed no significant influence on all the parameters in trauma group (F values:0.119,0.032,0.296,0.053,0.143; P values:0.733,0.859,0.592,0.821,0.709).Conclusions IVCM can clearly display the histological features of corneal subbasal nerve plexus in patients with ocular blunt trauma.Corneal subbasal nerve plexus were morphologically abnormal within 3 months after injury,and gradually underwent from atrophy to regeneration over time.%目的 探讨眼钝挫伤患者共聚焦显微镜下角膜基底下神经丛形态学变化的特征.方法 前瞻性研究.应用共聚焦显微镜观察2009年12月至2010年12月温州医科大学附属眼视光医院同一医师门诊就诊的2区或3区的单跟钝挫伤患者23例.以伤眼作为外伤组(23只眼),对侧眼为对照组(23只眼).两组同时完成伤后1周时的数据采集,外伤组再完成伤后1个月和3个月的随访,分别观察镜下角膜基底下神经丛形态变化特征并定量记录神经纤维密度、神经干数量、神经分支数、神经总数和神经弯曲度.计量资料组内比较采用配对t检验,计数资料组内比较采用Wilcoxon符号秩和检验,钝挫伤不同分区对角膜基底下神经丛变化的影响采用重复测量资料的方差分析.结果 外伤组各指标随时间均发生明显变化(F值分别为16.272、24.138、63.393、68.122、91.463,P值均＜0.01),其中神经密度、神经干数、神经分支数和神经总数在伤后1周时[分别为(624.0±109.9) μm/图,1.66根/图,6.70根/图,8.45根/图)较正常对照组[分别为(1677.9±87.1)μm/图,4.80根/图,8.98根/图,13.80根/图)]明显下降(t值分别为8.998,9.301,9.119,12.969,P值均＜0.01),并呈继续下降的明显趋势,除神经干数在伤后1周(1.66根/图)和1个月时(2.31根/图)差异无统计学意义(t=-1.518; P=0.143),神经弯曲度在1周时(1.66)较对照组(1.00)明显增大(t=-6.879;P＜0.01),并呈逐渐增大趋势,在伤后1个月(3.20)较1周时表现更为明显(t=-9.216;P ＜0.01),此时可以观察到神经再生.在伤后3个月时,各指标逐渐接近对照组水平,其中外伤组3个月时神经干(4.00根/图)、神经分支(8.69根/图)、神经总数(13.26根/图)和神经弯曲度(1.00)与对照组相比差异无统计学意义(t值分别为3.117,1.703,3.325,-1.837;P=0.079,0.792,0.392,0.392),而神经密度[(1064.3±93.3) μm/图]差异仍有统计学意义(=5.736;P＜0.01).外伤组不同分区对各指标结果的影响差异无统计学意义(F值分别为:0.119,0.032,0.296,0.053,0.143;p值为0.733,0.859,0.592,0.821,0.709).结论 共聚焦显微镜可以清晰地显示眼钝挫伤患者角膜基底下神经丛纤维的组织学特征的改变;眼钝挫伤后3个月内角膜基底下神经丛形态学异常,并在伤后依次经历了逐渐萎缩后再生修复的形态学变化过程.
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