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Candice G. Williams, Bernardo M. Cavalcanti, Andrea Cruzat, Monique Trinidad, Yesim Haussler-Sinangin, Reza Dana, Pedram Hamrah; In Vivo Confocal Microscopy as a Tool to Evaluate Cellular Changes in the Cornea and Conjunctiva in Ocular Allergy and Non-Allergic Ocular Inflammatory Diseases. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4016.
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To evaluate cellular changes on the conjunctiva and cornea in patients with ocular allergy and non-allergic ocular inflammatory diseases (OID) by in vivo confocal microscopy (IVCM).
Laser IVCM (HRT3/RCM) of the conjunctiva, central and peripheral cornea was performed in 6 patients (8 eyes) with ocular allergy (OA), 9 patients (10 eyes) with OID, and 6 control subjects (8 eyes) between March 2010 and September 2011. Images for each area were quantified for dendritic (DC) and non-dendritic immune cells (IC) density. Cellular and cell border reflectivity of superficial epithelial cells (SE) were evaluated. Conjunctival vessels were assessed for presence and location of immune cells.
Patients with OA and OID demonstrated increased hyperreflectivity of corneal (71% and 78%) and conjunctival SE (63% and 42%) as compared to controls (0%). SE cell border reflectivity in the area of tight junctions was increased in the cornea for OA and OID (83%) and the conjunctiva (77% OA; 70% OID) compared to controls (0% cornea; 11% conjunctiva). While central corneal DC density was lower in acute OA (46.8±31 cells/mm2) vs. acute OID (83.7±37) cases, patients with chronic OA (256.3±243) had higher DC density compared to chronic OID (65.6±56; p<0.05). In the peripheral cornea, a 35% (acute OA) and 90% (chronic OA) increase in DC density was observed as compared to controls. Moreover, conjunctival DC density was significantly increased in both OA (131.2±100) and OID (234.4±206) as compared to controls (17.5±16.2; p<0.05). Finally, conjunctival vessels demonstrated increased immune cell adhesion in OA (5.5±0.7 cells/100µm vessel length) and OID (5.7±1.7) compared to controls (0.13±0.35; p<0.05).
IVCM demonstrates profound immune and inflammatory changes in ocular allergic and non-allergic ocular inflammatory diseases. IVCM also shows superficial epithelial cell changes in the cornea and conjunctiva epithelium of patients with both OA and OID. IVCM provides a powerful platform for the evaluation of the ocular surface beyond slit-lamp examination and may provide a tool for patient stratification and objective assessment of treatment response in clinical trials through sensitive imaging biomarkers.
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