Abstract：Objective: To quantitatively analyze the corneal epithelial basal plexus in patients with different degrees of dry eye by image mosaic method and to explore its changes. Methods: Cross sectional study. A total of 91 eyes of dry eye patients (n=91) with mild dry eye (n=34), moderate dry eye (n=33), and severe dry eye (n=24) were recruited from the outpatient clinic of Shanxi Eye Hospital between April 2021 and October 2021. A total of 27 eyes (n=27) were recruited from normal healthy volunteers as the control group, and all subjects were selected for right eye data analysis. After routine ophthalmic examination, comprehensive ocular surface analyzer examination, and confocal microscopy of the cornea were performed for all subjects, the structural puzzle of the large corneal epithelial basal nerve plexus (SNP) was synthesized using Photoshop CC 2018 and captured as a vortex structure centered at 700 μm×700 μm of the images were analyzed, combined with the calculation of the total length of nerve fibers (NFL) in the images by the image J. The resulting data were converted from the image size to pixels to calculate the total length of nerve fibers per unit area (1 mm2 ), which was the value of nerve fiber density (mm/mm2 ). One way ANOVA was used to statistically compare the data in each group,while pairwise comparisons were made between the means of each group (LSD multiple comparisons), and Pearson's linear correlation was used to analyze the correlation between corneal nerve fiber density in each group and each index in the comprehensive analysis examination of the ocular surface. Result: Comparison of gender and age among the 4 groups showed no significant difference. In the control group, nerve fiber density was (22.71±6.19) mm/mm2 , Mild dry eye group was (28.58±5.19) mm/mm2 , Moderate dry eye group was (28.17±4.71) mm/mm2 , and Severe dry eye group was (5.98±7.32) mm/mm2,corneal SNP density was significantly different between groups (F=88.10, P<0.001). The density of SNP in the control group was significantly different from that in the mild,moderate,and severe dry eye groups (P<0.001), that in the mild dry eye group was not significantly different from that in the moderate dry eye group, and that in the mild,moderate dry eye group was significantly different from that in the severe dry eye group (P<0.001). There were no significant correlations between corneal SNP density and tear meniscus height, meibomian gland missing area score (superior+inferior) or ocular surface hyperemia score, a positive correlation with noninvasive breakup time (r=0.51, P<0.001), lipid layer grade (r=-0.30, P=0.004) and corneal fluorescein sodium staining grade (r=-0.68, P<0.001). Conclusion: The density and morphological changes of the basal nerve plexus in the corneal epithelium are associated with the severity grading of dry eye and can be used as a useful indicator for clinical assessment.
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