ABSTRACT
ABSTRACT Purpose: To examine subbasal corneal nerve changes in patients with bacterial infectious keratitis using in vivo confocal microscopy. Methods: Thirteen patients (13 eyes) with unilateral bacterial keratitis and 12 healthy controls were prospectively enrolled in the study. In vivo confocal microscopy was performed in all the patients at 2 time points, in the acute phase of infectious keratitis and at 28 ± 0.6 months after resolution of the infection. Results: The subbasal nerve length was 5.15 ± 1.03 mm/mm2 during the acute phase of bacterial keratitis (compared with that of the controls: 19.02 ± 1.78 mm/mm2, p<0.05). Despite the significant corneal nerve regeneration over the interval of 28 months after the resolution of the infection, the nerve density was still significantly reduced as compared with that of the controls (9.73 ± 0.93 mm/mm2, p<0.05). Moreover, in vivo confocal microscopy images showed diffuse high-reflecting areas referring to the scar tissue areas with thin and tortuous nerve branches regenerating toward these areas. Conclusions: A partial corneal nerve regeneration of subbasal nerve plexus during the first 28 months after the acute phase of infectious keratitis was observed. Moreover, the regenerated nerves of the patients remained morphologically altered as compared with those of the healthy controls. These results may be relevant to the clinical follow-up and surgical planning for these patients.
RESUMO Objetivo: Relatar as alterações no plexo nervoso corneano subbasal em pacientes com ceratite infecciosa de origem bacteriana utilizando a microscopia confocal in vivo. Métodos: Treze olhos de 13 pacientes com ceratite bacteriana unilateral e 12 indivíduos saudáveis como grupo controle foram incluídos prospectivamente no estudo. A microscopia confocal in vivo foi realizada em todos os pacientes em 2 momentos: na fase aguda da ceratite infecciosa e após 28 ± 0,6 meses da resolução da infecção. Resultados: A densidade dos nervos no plexo subbasal foi de 5,15 ± 1,03 mm/mm2 na fase aguda da ceratite infecciosa (comparada com o grupo controle: 19,02 ± 1,78 mm/mm2, p<0,05). Apesar de significativa regeneração dos nervos corneanos ao longo de um intervalo de 28 meses após a resolução da infecção, a densidade dos nervos se manteve significativamente reduzida (9,73 ± 0,93 mm/mm2) quando comparada com o grupo controle (19,02 ± 1,78 mm/mm2, p<0,05). Além disso, as imagens obtidas com a microscopia confocal mostraram áreas de hiperreflectividade referente ao tecido corneano cicatricial com ramos de nervos, afinados e tortuosos, se regenerando nessas áreas. Conclusões: Foi observado regeneração parcial dos nervos do plexo corneano subbasal durante os primeiro 28 meses após a resolução da fase aguda da ceratite infecciosa. Além disso, os nervos corneanos regenerados se mantiveram morfologicamente alterados quando comparados ao grupo controle. Esses resultados podem ser relevantes para o acompanhamento clínico e planejamento cirúrgico desses pacientes.
ABSTRACT
Background Corneal reinnervation of subbasal nerve plexus have been found after small incision lenticule extraction(SMILE).However,there were few reports about corneal reinnervation mode and dynamic changes at the corneal cap in different time points postoperation.Objective The aim of this study was to evaluate the corneal reinnervation at the cap margin after SMILE.Methods The clinical data of 32 myopic eyes of 16 patients who received SMILE incision lenticule extraction surgery in Affiliated Eye Hospital of Shandong Medical College from April 2014 to April 2015 were retrospectively analyzed.The following-up was carried in 1 week,1 month,3 months and 6 months after surgery,and in-vivo confocal microscopy was used to acquire images of the central corneal subbasal nerve plexus before and after surgery,with the scan range of 0.4 mm×0.4 mm,from which nerve density and nerve tortuosity were evaluated using Image-Pro Plus imaging analysis software.The overall length of nerve fibers at the central cornea was measured to assess the subbasal nerve density,and the repair of nerve fibers at cap was observed.Results The corneal subbasal nerve density was (19 687.45 ± 1 147.59),(10 500.46 ± 1 056.22),(12 833.40-± 1 047.98),(13 564.04-± 1 173.01) and (14 661.35-±941.92) μm/mm2 in preoperation and postoperative 1 week,1 month,3 months,6 months,respectively,with a significant difference among different time points (F =319.44,P=0.000),and the corneal subbasal nerve densitis in postoperative time points were significantly reduced in comparison with the preoperation,and corneal subbasal nerve densities were gradually increased after surgery as the extending of time,showing significant differences between different time points (all at P＜ 0.01).Abundant corneal subbasal nerve fibers were seen with the near normal morphology after surgery.However,the fragments and disaggregation of nerve fibers were found at the incision of cap margins,and some nerve fibers extended toward the inner cap at the non-incision of cap margins 1 week after surgery.In 3-6 months after SMILE,the continuous extension of nerve fibers was exhibited under the confocal microscope.Conclusions Six months after surgery,less invasive SMILE technique can remain the superficial corneal nerve fibers.Corneal innervation shows a radiate mode from peripheral cornea outside toward inside of the cap.The subbasal never fiber density is gradually increased with the extending of time after SMILE.
ABSTRACT
Background To understand the distribution and development of corneal nerve in animal or human has an important significance for clinical and basic research of corneal diseases.At present,some studies on cornea nerve development and location have been performed.However,the quantified study on innervation and distribution of corneal nerve fibers as embryonic development has not been reported.Objective This study attempted to understand the distribution of corneal nerve fibers in the development of chick embryo,and to evaluate the changes of the length and density of corneal nerve fibers with aging of chick embryo.Methods Whole chick corneas with limbus were obtained from chick embryo aged 6-20 days (E6-E20),and corneal nerve fiber was labeled using immunofluorescence technique by anti-neuron-specific β-Ⅲ tubulin antibody.The corneas were radially cut into 4 parts,and the integrate corneal flat mounts were prepared with the upward epithelium and mounting with anti-fade fluorescent quenching buffer glycerin containing DAPI.Fluorescence microscope was used to capture the nerve fiber images in cornea,and cornea area and the number of nerve fiber bundles were exhibited by using Photoshop CS4.Cornea nerve fiber density and total length were measured by Imaris x64 7.4.2 software.Results Total cornea flat mounts showed that the nerve bundles grew from temporal scleral forward cornea limbus at E6-E8,and the nerve fibers formed the ring surrounding by limbus during E9-E10.Then the fibers extended forward the central cornea in E11 to E15 and developed into nerve fiber plexus on the whole cornea in E16 to E20.During the period of E6-E20,the corneal surface area,the length and density of corneal nerve fibers were gradually increased with the aging of chick embryo,showing statistically significant differences among different time points (F =127.007,227.051,67.748,all at P＜0.01).The increase of the corneal area of the chick embryo presented a strong positive correlation with the extending of length of the corneal nerve fiber (r =0.863,P＜0.01).Chick corneal nerve fiber bundle appeared at E13,with a number of (59.00 ± 1.14)/mm2 and then increased to a peak of (576.75 ±29.16)/mm2 at E 18 and reduced to (299.67± 25.46)/mm2 at E20,with a significant difference among them (F =13.759,P=0.000).Conclusions Corneal nerve starts to develop in E9 of chick embryo,and the corneal surface area,the total length of the corneal nerve fibers and the density rapidly increase concurrently with the development of chick embryo.
ABSTRACT
Objective Although the ocular motility examination has been traditionally used in the diagnosis of complex strabismus resulting from cranial nerve (CN) and extraocular muscles (EOM) abnormalities, magnetic resonance imaging (MRI) now permits the direct imaging of lesions in CNs and EOMs. Methods Twenty-six patients with complex strabismus underwent MRI examination on 1.5 T MR unit (Twinspeed, GE). Nerves to EOMs were imaged with T1 weighted in orbits in all patients using phase array surface colls. Results Patients with Duane syndrome ( 15 cases, 19 eyes) all exhibited absence or hypoplasia of abducens nerve (CN6), always with mild hypoplasia and apparent misdirection of oculomotor nerve ( CN3 ) to the lateral rectus muscle in the orbit, and there were no hypoplasia of EOMs. Patients with congenital fibrosis of EOMs (9 cases, 16 eyes) exhibited severe hypoplasia of CN3 and CN6, and EOMs appeared hypoplasia to a different degree, particularly severe for the superior rectus and levated palpted muscles. Multiple nerves displayed aplasia in patients with Mobius syndrome (1 case, 2 eyes) and there was abnormal branch from CN3 to lateral rectus. The tendons of bilateral superior oblique muscles were thin in the patients with Brown syndrome ( 1 case, 2 eyes). Conclusion MRI can directly demonstrate absence or hypoplasia of CNs and corresponding EOM abnormalities in congenital complex strabismus, which suggests that the mechanism of congenital complex strabismus is perhaps abnormal innervation or displasia of the ocular motor nerves.
ABSTRACT
In the microsurgical dissection of the lateral wall of the cavernous sinus, interrelationships of its nerves have been studied in 100 Korean adult half heads. And in the serial coronal section of the cavernous sinus in 10 half heads, the structures of the lateral wall have been studied. The relationships of the nerves of the lateral wall were classified to five types according to the course of the trochlear nerve. Each length of the Parkinson's triangle and the angle between trochlear and ophthalmic nerves were measured. There data were compared with those of the other races. The lateral wall of the sinus was composed of two layers. The orientation of the fibers of the deep layer was variable in regions. The oculomotor nerve was enveloped with sheath extended from dura mater and it was connected with deep layer of the lateral wall. The trochlear nerve was enveloped with sheath formed y division of innermost part of the deep layer. The venous sinus was found between the two layers of the lateral wall. The neurosurgical significance of the lateral wall of the sinus was discussed.
Subject(s)
Adult , Humans , Cavernous Sinus , Racial Groups , Dura Mater , Head , Oculomotor Nerve , Ophthalmic Nerve , Trochlear NerveABSTRACT
A morphometric study on the trigeminal ganglion and the intracranial portion of the ophthalmic, maxillary and mandibular nerves was done in 50 Korean adult cadavers. The shape of the ganglion was classified into 7 types and semicircular shape was most common (54%). Mean width of the trigeminal root at porus trieminus was 6.08mm. The length of the trigemnal root from porus to the trigeminal ganglion was 8.28mm at ophthalmic portion, 10.16mm at maxillary portion, and 8.90mm at mendibular portion. Maximum width of the ganglion was 15.48mm and the breadth of the ophthalmic, and maxillary portion were 5.25mm and 5.26mm, respectively, and that of the mandibular portion (4.92mm) was narrow than the other portion. Intracranial ophthalmic nerve was 4.30mm of width and 17.89mm of length, and this nerve inclined average 39.7。 (range 14.56。) from sagital plane. It was observed infrequently that the cavernous sinus extended to the lateral border of the maxillary nervw and the emissary sinus ran under the mandibular nerve.