Effects Of 0.05% Cyclosporine Eye Drops(Ⅱ) On Corneal Nerves In Moderate To Severe Dry Eye Patients

Purpose:To investigate the therapeutic effect of domestic cyclosporine on dry eye disease and corneal sub-basal nerves by observing the main symptoms and signs of dry eye and the changes of the number and morphology of corneal sub-basal nerve before and after the treatment of moderate and severe dry eye with 0.05%cyclosporine eye dropsⅡMethods:In this prospective study,20 patients(20 eyes)with moderate to severe dry eye disease were treated with 0.05%cyclosporine(Cs A)eye dropsⅡduring a 3-month follow-up period.Clinical evaluation was carried out at baseline and at months3.All patients completed the Ocular Surface Disease Index(OSDI)questionnaire,and underwent tear film break-up time(TBUT),Schirmer test(SchirmerⅠ),corneal fluorescein sodium staining(CFS)and in vivo confocal microscopic(IVCM).Paired sample T test was used to analyze the symptoms,signs and corneal nerve changes before and after treatment,and Pearson correlation analysis was used to study the correlation between dendritic cells and nerve injury.Results:1.After 3 months of treatment,the Ocular Surface Disease Index(OSDI)questionnaire score decreased from 54.2±8.19 to 34.95±8.57,and the tear film break-up time(TBUT)increased from 2.13±1.13s to 3.92±1.30s.SchirmerⅠincreased from2.93±1.49mm/5min to 7.21±3.37mm/5min,corneal fluorescein staining score(CFS)decreased from 7.25±2.71 to 4.00±2.79,symptoms and signs were significantly improved.2.Confocal microscopy data analysis showed that during follow-up,Corneal nerve total number increased from 9.34±4.55 per frame at baseline to 9.67±4.21 per frame at 3 month(p=0.158),but this difference was not statistically significant;Corneal nerve branch number decreased from 4.87±3.84 per frame at baseline to4.74±3.11 per frame at 3 month(p=0.899),but this difference was not statistically significant;Corneal subbasal nerve density increased from 13.49±5.43 mm/mm~2at baseline to 14.93±5.34 mm/mm~2at 3 months(p<0.001),nerve tortuosity decreased from 2.86±0.92 at baseline to 2.31±0.75 at 3 months(P<0.001);number of beadings decreased from1.45±0.67/100μm to 1.07±0.45/100μm(P<0.001),number of dendritic cell(DC)decreased from 5.83±3.28 per frame to 3.67±2.24 per frame((P<0.001).3.The number of dendritic cell(DC)was positively correlated with the number of branch nerves,the grade of nerve tortuosity and the number of nerve beading.(r=0.27,P=0.045;r=0.407,P<0.01;r=0.486,P<0.01).Conclusions:0.05%Cs A can effectively improve the morphology of corneal sub-basal nerve,increase nerve density and reduce the number of dendritic cells,and DC is positively correlated with the number of branch nerves,the grade of corneal tortuosity and the number of beading.The observation of corneal subbasal nerve by confocal microscope can be used as an effective method to evaluate the therapeutic effect of patients with dry eyes.