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Clara M. Colon, Bernardo M. Cavalcanti, Andrea Cruzat, Yureeda Qazi, Candice Williams, Douglas B. Critser, Amy Watts, Charles Leahy, Christine W. Sindt, Pedram Hamrah; In Vivo Confocal Microscopy of Immune Cells in the Cornea of Normal Subjects Demonstrates Irregular Peripheral Distribution of Dendritic Cells. Invest. Ophthalmol. Vis. Sci. 2012;53(14):94.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the density of epithelial immune cells in the central and four peripheral quadrants in corneas of normal subjects.
Sixty-five normal subjects (130 eyes) were enrolled and underwent laser in vivo confocal microscopy (IVCM; HRT3/RCM) of the central cornea, as well as superior, inferior, nasal, and temporal quadrants. Slit-lamp examination was performed to confirm lack of ocular findings. Images were assessed for dendritic cells (DC) and non-dendritic immune cells (IC) density by three masked observers. Statistical analysis was performed with ANOVA with Bonferroni correction to compare the differences between the 5 areas.
IVCM revealed the presence of central and peripheral corneal DC in all subjects. The mean ± SD DC density was 41.01 ± 48.03 cells/mm2 centrally. Interestingly, while DC density was higher in all 4 quadrants (p-value <0.0001), the superior and inferior quadrants demonstrate the highest DC density with 95.2 ± 49.6 cells/mm2 superiorly and 108.8 ± 75.2 cells/mm2 inferiorly as compared to 49.3 ± 28.11 cells/mm2 temporally and 60.6 ± 41.5 cells/mm2 nasally. IC density was overall extremely low with highest density temporally (1.2 ± 3.8 cells/mm2) and lowest density centrally (0.7 ± 2.0 cells/mm2), although no statistical difference was detected when comparing the five areas. Excellent inter-observer variability was observed between observers (r=0.96) for all areas combined.
IVCM revealed increased peripheral DC density as compared to the central cornea. Significant variation in DC density was observed between peripheral quadrants. This variability suggests that measurement of peripheral DC density should not be performed randomly for cross-sectional and longitudinal studies. With the increased use of IVCM to detect subclinical inflammatory changes, the normative data may serve as the basis for future clinical studies and trials.
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