Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China
Abstract：Objective: To investigate the mosaic in-vivo confocal microscopy (IVCM) corneal nerve image processing method, and to analyze the morphology of the corneal subbasal nerves and their relationship to clinical parameters in patients with dry eye syndrome. Methods: In this case series study, 16 patients (16 eyes) with dry eye syndrome were recruited from the Department of Ophthalmology, Peking University People's Hospital from January 2021 to May 2021. The non-invasive tear meniscus height (NITMH), non-invasive break up time (NITBUT), tear break up time (TBUT), corneal fluorescein staining (FL), the dropout of the meibomian gland, Schirmer Ⅰ test (SⅠT) and IVCM were examined. Both the traditional method and the new mosaic image processing method were used for corneal nerve morphology analysis. Measurements included area, total nerve length, nerve density, mean length, maximum length, minimum length, nerve number and nerve density, etc. The right eye of each subject was included in this study. A Wilcoxon rank sum test was used to compare the differences in the variables between the two methods, and Spearman correlation analysis was used to determine the correlation between dry eye clinical parameters and corneal nerve variables for the 2 methods. Results: The area, total nerve length, nerve density, mean length, maximum length and nerve number were all larger and longer with the new mosaic image processing method than with the traditional method (all P<0.05). The minimum length was shorter in the new mosaic image processing method (P<0.001). There was no statistically significant difference in nerve density between the two methods. Using the traditional method, NIKBUT was correlated with mean length, nerve number and nerve density (r=0.52, P=0.037; r=-0.62, P=0.011; r=-0.62, P=0.011). Other dry eye parameters were not associated with the corneal nerve analysis parameters. NIKBUT was only correlated with nerve density (r=-0.56, P=0.025) using the mosaic image processing method, while other dry eye parameters were not associated with corneal nerve analysis parameters. Conclusions: Compared to the traditional method, using the new mosaic image processing method provides a corneal assessment over a larger area. The correlations for corneal nerve analysis parameters, and some dry eye clinical parameters and corneal nerve analysis parameters are different between the two methods. The new corneal nerve analysis method can analyze a larger area, is more accurate, and more reliable for corneal subbasal nerve analysis in dry eye patients.
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