Abstract
Purpose: :
To test the hypothesis that patients with ocular cicatrcial pemphigoid (OCP) have a significant degree of inflammation and lymphocytic infiltration in conjunctival epithelium, and immunological changes of the cornea.
Methods: :
OCP patients were identified, and Schirmer test, fluorescein staining, lissamine green staining, tear break-up time, and impression cytology of the conjunctiva were performed in 12 patients and 12 age-matched controls. Impression cytology samples were preserved in cell culture medium supplemented with 10% Foetal Calf Serum and analyzed for HLA-DR, CD3, CD8, and CD4 expression by flow cytometry. The central cornea was examined by in vivo confocal microscopy using a 40x lens and an axial resolution of 5 µm in both groups.
Results: :
Statistically significant changes in corneal fluorescein and conjunctival lissamine green staining occurred in the study group compared to controls, while tear secretion did not show any differences. Cytofluorimetric analysis revealed that besides higher HLA-DR expression on conjunctival cells, CD3+CD4+ cells increased in OCP patients compared to controls. Furthermore CD4/CD8 ratio reverted from 1/9 in controls to 3/2 in the study group. In patients with OCP confocal microscopy images showed numerous highly reflective dendritic-like cells and their density correlated with HLA-DR.
Conclusions: :
In OCP the ocular surface is characterized by inflammation of the conjunctiva with increased CD4+ lymphocyte infiltration and immunological and structural changes of the cornea which confirm the importance of local and systemic anti-inflammatory therapy in the early stages of the disease and the risks related to surgical procedures.
Keywords: conjunctiva • inflammation