June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
In Vivo Confocal Microscopy in Patients with Dry Eye Disease Demonstrates Decreased Peripheral Corneal Nerve Density and Correlation to Clinical Signs
Author Affiliations & Notes
  • Adam Tanaka
    Center for Translational Ocular Immunology, Tufts Medical Center, Boston, Massachusetts, United States
  • zeina salem
    Cornea Service, New England Eye Center, and Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Gabriela Dieckmann
    Center for Translational Ocular Immunology, Tufts Medical Center, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, and Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Paula Kataguiri
    Center for Translational Ocular Immunology, Tufts Medical Center, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, and Department of Ophthalmology, 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
    Center for Translational Ocular Immunology, Tufts Medical Center, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, and Department of Ophthalmology, Tufts Medical Center, 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
  • 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
    Center for Translational Ocular Immunology, Tufts Medical Center, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, and Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Adam Tanaka, None; zeina salem, None; Gabriela Dieckmann, None; Paula Kataguiri, None; Shruti Aggarwal, None; Rodrigo Muller, None; Bernardo Cavalcanti, 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, 3753. doi:
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    • Get Citation

      Adam Tanaka, zeina salem, Gabriela Dieckmann, Paula Kataguiri, Shruti Aggarwal, Rodrigo T Muller, Bernardo Cavalcanti, Andrea Cruzat, Ahmad Kheirkhah, Pedram Hamrah; In Vivo Confocal Microscopy in Patients with Dry Eye Disease Demonstrates Decreased Peripheral Corneal Nerve Density and Correlation to Clinical Signs. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3753.

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

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Abstract

Purpose : To evaluate the peripheral corneal nerve alterations in patients with dry eye disease (DED) as correlated to clinical signs and symptoms.

Methods : This is a prospective, cross-sectional, cohort study of 46 patients with DED. In vivo confocal microscopy (IVCM) images were taken for the central cornea and 4 peripheral quadrants. Images were analyzed for main trunk, branch and total nerve densities (mm/mm2) in a masked fashion. Clinical symptoms and signs were assessed using Ocular Surface Disease Index (OSDI), corneal (CFS) and conjunctival lissamine green staining (LGS), Schirmer’s test, and tear break-up time (TBUT), and correlated to IVCM parameters. A P value of <0.05 was considered statistically significant.

Results : The mean symptoms score was 46.29±28.61. Mean TBUT was 2.78±2.08”, mean CFS was 3.91±3.12, mean LGS was 4.37±2.88, and mean Schirmer’s score was 12.83±10.50 mm. The mean peripheral nerve densities ranged 11.26±5.98 to 14.76±7.60 for total nerves, 1.87±1.02 to 2.10±1.80 for main trunks, and 7.09±3.92 and 9.14±4.77 for branches. CFS correlated with total nerve density in the nasal, temporal, superior and inferior quadrants (P<0.001; r=-0.42, r=-0.39, r=-0.36, r=-0.47), main trunk density (P<0.01; r=-0.36, r=-0.37, r=-0.33, r=-0.39), and branch nerve density (P<0.01; r=-0.40, r= -0.39, r=-0.29, r=-0.43). LGS also correlated with total nerve density in the nasal, temporal and inferior quadrants (P<0.01, r=-0.40, r=-0.34, r=-0.34), main trunk density (P<0.01, r=-0.39, r=-0.44, r=-0.35), and branch nerve density (P<0.05, r=-0.38, r=-0.43, r=-0.43). TBUT correlated with total nerve density in nasal, temporal, superior and inferior (P<0.05, r=0.57, r=0.40, r=0.50, r=0.58), main trunk density (P<0.001, r=0.52, r=0.55, r=0.51, r=0.57) and branch nerve density (P<0.01, r=0.51, r=0.47, r=0.38, r=0.50). No significant correlation was found between peripheral corneal nerve density and OSDI scores.

Conclusions : Patients with DED demonstrate a significant reduction of peripheral corneal nerve density, which correlates to dry eye signs. Dry eye symptoms did not show significant correlation to IVCM parameters.

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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