June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Clinical Signs of Dry Eye Disease are Correlated to Peripheral Corneal Immune Cell Alterations by In Vivo Confocal Microscopy
Author Affiliations & Notes
  • Paula Kataguiri
    Ophthalmology, New England Eye Center/Tufts Medical Center, Boston, Massachusetts, United States
  • Gabriela Dieckmann
    Ophthalmology, New England Eye Center/Tufts Medical Center, Boston, Massachusetts, United States
  • Shruti Aggarwal
    Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Rodrigo T Muller
    Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Bernardo Cavalcanti
    Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Yureeda Qazi
    Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
    Ophthalmology, New England Eye Center/Tufts Medical Center, Boston, Massachusetts, United States
  • Andrea Cruzat
    Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Ahmad Kheirkhah
    Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Pedram Hamrah
    Ophthalmology, New England Eye Center/Tufts Medical Center, Boston, Massachusetts, United States
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Paula Kataguiri, None; Gabriela Dieckmann, None; Shruti Aggarwal, None; Rodrigo Muller, None; Bernardo Cavalcanti, None; Yureeda Qazi, None; Andrea Cruzat, None; Ahmad Kheirkhah, None; Pedram Hamrah, Alcon (F), Allergan (C), Allergan (F), Bausch&Lomb (C), Dompe (C), Dompe (F), Eyegate Pharmaceuticals (C), GlaxoSmithKline (C), GlaxoSmithKline (F), Heidelberg Engineering (C), Jade Pharmaceuticals (C), Novabay (C), Santen Inc. (C), Shire (C), Shire (F), Stemnion (C), Tissue-Tech (C), Tissue-Tech (F), Valeant (C)
  • Footnotes
    Support  Allergan, Inc., Irvine, CA; NIH R01-EY022695, Massachusetts Lions Eye Foundation
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2664. doi:
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      Paula Kataguiri, Gabriela Dieckmann, Shruti Aggarwal, Rodrigo T Muller, Bernardo Cavalcanti, Yureeda Qazi, Andrea Cruzat, Ahmad Kheirkhah, Pedram Hamrah; Clinical Signs of Dry Eye Disease are Correlated to Peripheral Corneal Immune Cell Alterations by In Vivo Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2664.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Inflammation has been recognized to play a major role in the pathogenesis of dry eye disease (DED). In vivo confocal microscopy (IVCM) is a sensitive tool for detecting subclinical inflammation. In this study, we aimed to assess epithelial corneal dendritiform immune cell (DC) alterations in the peripheral cornea of patients with DED and to correlate these to clinical signs and symptoms.

Methods : This is a prospective, cross-sectional, cohort study of 46 patients with DED. Corneal IVCM images were in all 4 peripheral quadrants. Three representative images were analyzed for DC density and morphology (DC area and DC field) by two masked observers and correlated to ocular surface disease index (OSDI), corneal (CFS) and conjunctival staining (CS; NEI scales), Schirmer’s test and tear break-up time (TBUT). DED severity (1-4) was based on Dry Eye Workshop (DEWS). P value <0.05 was considered statistically significant.

Results : The mean symptom score was 46.2±28.6 for OSDI. Mean signs were 3.9±3.1 for CFS, 4.3±2.8 for CS, 2.7±2 seconds for TBUT, and 12.8±10.5 mm for Schirmer’s test. DC density, area and field in the peripheral corneal quadrants ranged from 49.2±49.1 to 84.7±77.7 cells/mm2, 145.8±52.1 to 150.9±62.7m2 and 208.5±115.3 to 351.9±286.5m2. In the nasal quadrant, there was a correlation between DC density and CFS (p=0.001, R=0.40), and DC density and TBUT (p=0.03, R=-0.28); in the temporal quadrant, correlation was found between DC density and CFS (p=0.008, R=0.4), DC density and CS (p=0.015, R=0.3), and DC density and TBUT (p=0.009, R=-0.34). For the superior cornea, DC field correlated with TBUT (p=0.001, R=-0.49), and CS (p=0.02, R=0.29) and DC density correlated with the CS (p=0.048, R=0.24). Finally, for inferior quadrant, DC density correlated with TBUT (p=0.004, R=-0.37), CFS (p=0.006, R=0.33) and CS (p=0.04, R=0.35). No statistical difference was found comparing IVCM findings in relation to OSDI or DED severity level.

Conclusions : This study demonstrates a correlation between peripheral corneal IVCM findings and clinical signs, in particular for the nasal and temporal quadrants as early as in DEWS grade 1. No statistical difference was found comparing IVCM findings with DED severity level or symptoms. Reversal of these differential changes may be used to evaluate efficacy of anti-inflammatory DED treatment.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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