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Effects of corneal nerve density on the response to treatment in dry eye disease
- Source :
- Ophthalmology. 122(4)
- Publication Year :
- 2014
-
Abstract
- To evaluate whether levels of corneal subbasal nerve fiber length (SNFL) in dry eye disease (DED) could prognosticate the level of improvement in signs and symptoms after treatment.Phase IV, double-masked, randomized clinical trial.Sixty patients with meibomian gland dysfunction-associated DED and 27 age-matched controls.Patients with DED were randomized to receive topical artificial tears, loteprednol etabonate 0.5%, or loteprednol etabonate 0.5%/tobramycin 0.3% twice daily for 4 weeks. At baseline, in vivo confocal microscopy of central cornea was performed in both eyes. Patients with DED were divided into 2 subgroups: those with low baseline SNFL and those with near-normal baseline SNFL for this purpose (the cutoff point: the mean SNFL in controls minus 2 standard deviations). Clinical signs and symptoms at baseline and after 4 weeks of treatment were compared between the subgroups with low and near-normal SNFL for all therapeutic groups.Symptom questionnaires, corneal fluorescein staining (CFS), conjunctival staining with lissamine green, tear break-up time, Schirmer's test, and SNFL.In patients with DED, baseline SNFL (17.06±5.78 mm/mm(2)) was significantly lower than in controls (23.68±3.42 mm/mm(2), P = 0.001). In the artificial tear and loteprednol groups, although no significant improvement in any sign or symptom was noted in patients with low baseline SNFL (16.84 mm/mm(2)), subjects with near-normal baseline SNFL (≥16.84 mm/mm(2)) showed significant improvement in both symptoms and CFS score (all P0.05). In the loteprednol/tobramycin group, no significant change was evident for any sign or symptom in either subgroup of low or near-normal baseline SNFL.Significant improvements in CFS and patient symptomatology after DED treatment were evident only in the subgroup with near-normal corneal SNFL. Consideration of SNFL may assist in explaining the variability of patients' response to DED therapy.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Dry Eye Syndromes
Meibomian gland
Ophthalmic Nerve
Lubricant Eye Drops
Article
law.invention
Cornea
Randomized controlled trial
Double-Blind Method
law
Ophthalmology
Surveys and Questionnaires
Anti-Allergic Agents
medicine
Humans
Ocular Surface Disease Index
Prospective Studies
Prospective cohort study
Microscopy, Confocal
business.industry
Loteprednol Etabonate
Meibomian Glands
Middle Aged
Anti-Bacterial Agents
Androstadienes
Artificial tears
medicine.anatomical_structure
Loteprednol
Eyelid Diseases
Tobramycin
Drug Therapy, Combination
Female
Ophthalmic Solutions
business
medicine.drug
Subjects
Details
- ISSN :
- 15494713
- Volume :
- 122
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Ophthalmology
- Accession number :
- edsair.doi.dedup.....44286f41cb713256a642c177c5a8b786