研究目的
To evaluate in vivo confocal microscopy (IVCM) features of corneal subbasal nerve plexus (SNP) in the setting of dry eye disease (DED) using fully automated software BACCMetrics,^ and to further investigate its diagnostic performance in discriminating DED patients.
研究成果
ACCMetrics software effectively detected alterations in corneal subbasal nerve plexus in dry eye disease patients, showing lower CNFD, CNBD, CNFL and higher CNFW compared to controls. CNFW had the highest diagnostic power (AUC=0.828), and combining CNFW and CNBD achieved high sensitivity (97.4%) but lower specificity (46.7%). The study demonstrates the utility of automated IVCM analysis for DED diagnosis, with potential for enhanced research and clinical application despite limitations in sample size and parameter scope.
研究不足
Small sample size limited to tertiary center patients with Sj?gren’s syndrome or ocular GVHD, potentially not generalizable to milder DED cases. ACCMetrics does not analyze nerve tortuosity, a known metric in DED, and may have false-negative/positive errors in detecting thin nerves or other structures. Larger datasets and inclusion of tortuosity parameter could improve validation and diagnostic performance.
1：Experimental Design and Method Selection:
Cross-sectional study design using in vivo confocal microscopy (IVCM) with fully automated software ACCMetrics for morphometric analysis of corneal subbasal nerve plexus (SNP). Statistical methods included Mann–Whitney U test for comparisons and receiver operating characteristic (ROC) curves for diagnostic accuracy assessment.
2：Sample Selection and Data Sources:
Included 39 patients with moderate to severe DED (Sj?gren’s syndrome or ocular graft versus host disease) and 30 age- and sex-matched healthy controls. Exclusion criteria included use of topical steroids/antibiotics, contact lens wearing, previous corneal surgery, certain ocular diseases, and diabetes. Data collected from S.Orsola-Malpighi University Hospital, Bologna, Italy.
3：List of Experimental Equipment and Materials:
Heidelberg Retina Tomograph with Rostock Cornea Module (HRT/RCM, Heidelberg Engineering, Heidelberg, Germany) for IVCM exams; Cochet-Bonnet esthesiometer (Luneau Chartres, France) for corneal sensitivity; Schirmer test strips; slit-lamp; ACCMetrics software (MADabbah, Imaging Science and Biomedical Engineering, Manchester, UK) for automated image analysis; SPSS statistical software (SPSS Inc., Chicago, Illinois, USA) for data analysis.
4：Experimental Procedures and Operational Workflow:
Ocular surface workup included slit-lamp exam, corneal sensitivity measurement, Schirmer test, tear film break-up time, staining scores, and symptom questionnaires. IVCM performed with HRT/RCM, recording 100 images per sequence from SNP layer (depth 50-80 μm). Three best images selected per subject and analyzed with ACCMetrics to compute seven nerve parameters. Statistical analysis compared groups and calculated ROC curves.
5：Data Analysis Methods:
Mann–Whitney U test for continuous variables, ROC curves with AUC calculations, sensitivity and specificity determinations, and Venn diagram analysis for parameter combinations.
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