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Tudor Cosmin Tepelus, Gloria Chiu, Jyotsna Maram, Vikas Chopra, Srinivas R Sadda, Olivia L Lee; Characterization of Corneal Features in Ocular Graft Versus Host Disease by in vivo Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5448.
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To describe the morphological features of the corneal epithelial layers, sub-basal nerve plexus and anterior stroma in patients with ocular Graft-versus-host disease (oGVHD) by using in vivo confocal microscopy (IVCM).
Central cornea images were prospectively captured bilaterally from 5 healthy controls and 10 patients with clinically diagnosed oGVHD using In Vivo Laser Scanning Confocal Microscopy (HRT III RCM). Morphological changes of the corneal epithelial layers and anterior stroma, as well as sub-basal nerve appearance, density and tortuosity were evaluated.
Images obtained by IVCM from 30 eyes were analyzed. As compared to controls, eyes with oGVHD displayed increased density of epithelial dendritic cells and other inflammatory cells. IVCM showed corneal epithelial metaplasia and polymorphism, with hyperreflective enlarged cells, activated nuclei and decreased nucleus/cytoplasm ratio. Images of the sub-basal nerve plexus in oGVHD demonstrate significant reduction in density and increased tortuosity of corneal nerves for eyes with mild to moderately severe GVHD as compared to normal controls (1693±1008 vs. 3408±577 µm/frame, p<0.001). Eyes with clinical presentation of severe GVHD, however, demonstrated complete absence of sub-basal nerves. In oGVHD eyes as compared to normal controls, visible networks of activated keratocytes in the anterior stroma with pleomorphism are seen.
IVCM reveals profound and significant microstructural changes in the corneas of patients with oGVHD as compared to normal corneas. These features are consistent within the oGVHD group, being proportional to the severity of the disease. Our findings suggest implications for use of IVCM in the evaluation and monitoring of patients with ocular manifestations of GVHD.
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