April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Dry Eye Response to Topical Steroids: an in vivo Confocal Study
Author Affiliations & Notes
  • Edoardo Villani
    Clinical Sciences and Community Health, University of Milan, Milan, Italy
    University Eye Clinic, San Giuseppe Hospital, Milan, Italy
  • Elena Garoli
    Clinical Sciences and Community Health, University of Milan, Milan, Italy
    Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • Veronica Canton
    Clinical Sciences and Community Health, University of Milan, Milan, Italy
    Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • Vittoria Termine
    Clinical Sciences and Community Health, University of Milan, Milan, Italy
  • Roberto Ratiglia
    Clinical Sciences and Community Health, University of Milan, Milan, Italy
    Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  • Paolo Nucci
    Clinical Sciences and Community Health, University of Milan, Milan, Italy
    University Eye Clinic, San Giuseppe Hospital, Milan, Italy
  • Footnotes
    Commercial Relationships Edoardo Villani, None; Elena Garoli, None; Veronica Canton, None; Vittoria Termine, None; Roberto Ratiglia, None; Paolo Nucci, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3689. doi:
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      Edoardo Villani, Elena Garoli, Veronica Canton, Vittoria Termine, Roberto Ratiglia, Paolo Nucci; Dry Eye Response to Topical Steroids: an in vivo Confocal Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3689.

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

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Abstract
 
Purpose
 

To evaluate, in moderate to severe dry eye patients treated with topical corticosteroids, the in vivo laser scanning confocal microscopy (LSCM) corneal findings and their association with clinical response to treatment.

 
Methods
 

We consecutively recruited 50 patients with moderate to severe dry eye. Exclusion criteria were trauma or surgery in the previous 6 months, any systemic or ocular disease (other than dry eye) and any systemic or topical treatment (except artificial tears), ongoing or performed in the previous 3 months, with known effect on the ocular surface. Baseline and follow-up visits included Ocular Surface Disease Index (OSDI) questionnaire, full eye exam and LSCM study of central cornea (including superficial and basal epithelial cells density, anterior, posterior and activated keratocytes density, sub-basal dendritic cells density (DCD), and sub-basal nerves length and tortuosity). All patients were treated with loteprednol etabonate q.i.d. for 4 weeks. The follow-up visit was performed 30±2 days after the baseline. We compared clinical and confocal data obtained before and after treatment and looked for associations between baseline data and steroids-induced changes. Basing on the previously validated OSDI Minimal Clinically Important Difference, we re-analyzed the baseline findings comparing steroids responders to not-responders. Statistical analysis considered the worst eye.

 
Results
 

OSDI score and DCD significantly decreased after treatment (Paired samples t-test: 41.8±20.9 vs 52.3±20.7, P<0.01 and 64.3±45 vs 138.4±106.7cells/mm2, P<0.01, respectively). DCD baseline values showed significant correlations with both OSDI and DCD steroid-related changes (r=0.44, P<0.05 and r=0.70, P<0.01, respectively). Baseline mean DCD was significantly higher in responders to steroids compared to not-responders (Independent samples t-test: 164.1±109.2 vs 110.8±45.5; P<0.05).

 
Conclusions
 

In vivo confocal evaluation of DCD is effective in detecting steroid-related corneal inflammation changes. DCD baseline values are associated to symptoms' improvement after treatment. These promising preliminary data suggest the need for future studies, designed to test the predictive value of DCD for clinical response to steroids treatment.

 
 
Confocal images showing DCD in a patient responder to steroids (A, B) and in a not-responder one (C, D) before (A, C) and after (B, D) 4 weeks of treatment.
 
Confocal images showing DCD in a patient responder to steroids (A, B) and in a not-responder one (C, D) before (A, C) and after (B, D) 4 weeks of treatment.
 
Keywords: 486 cornea: tears/tear film/dry eye • 596 microscopy: confocal/tunneling • 557 inflammation  
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