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Eun Young Choi, Sung Hoon Lee, Hyun Goo Kang, Eung Kweon Kim, Hyung Keun Lee, Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.; Determination of dendritic cell activation and morphological changes in dry eye imaging by in vivo confocal microscopy.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4032. doi: https://doi.org/.
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Dendritic cells (DCs) are responsible for generating and tolerating immune response in the cornea. Despite the general consensus by experimentation that immune reaction is involved in the pathogenesis of not only Sjögren but also of non-Sjögren dry eye (DE), the frequencies, anatomic location and characteristics of corneal DCs are not well defined clinically. We performed a prospective, observational clinical study to investigate the alterations of corneal DCs in non-Sjögren DE and hypothesized that self-reported symptoms might be related to the observed pathologic changes of DCs.
Fifty-four DE and 23 healthy control subjects were included. DE patients were divided into two groups depending on the severity of symptoms; those with VAS scores of 0 to 5 were categorized as low VAS score group (LVS, N=26) while 6 to 10 as high VAS score group (HVS, N=28). Tear film break-up time, fluorescein staining, Schirmer test results and imaging of layered microstructures of central cornea with in vivo confocal microscopy (IVCM) were performed on both eyes of each patient. One eye of each subject was included in the study. Cell densities and morphological characteristics were analyzed by ImageJ software.
DC infiltration was observed in the subbasal layer, with higher density in HVS and LVS as compared to the control groups (P=0.007). DCs showed more expanded cell area (P=0.001) and increased number of digitation (P=0.17) with longer length of each process (P=0.001) in LVS compared to HVS and control groups. The DC area was positively correlated with number and length of DC process (r=0.66 and 0.42 P<0.05).
The increased infiltration and morphologic changes of epithelial DCs in DE were visualized by confocal microscope. It was noticeable that in DE patients with more severe symptoms, the number and length of DC processes were observed to be reduced when compared to symptomatically mild DE. It is suggesting remarkable clinical evidence for the immunopathogenesis of DE.
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