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C. Valente, S. Barabino, C. Mingari, M. Papadia, F. Solignani, P. Vacca, M. Bertolotto, M. Rolando; Ocular Surface Changes in Patients With Cicatricial Pemphigoid. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2365.
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© ARVO (1962-2015); The Authors (2016-present)
To test the hypothesis that patients with ocular cicatricial pemphigoid (OCP) have a significant degree of conjunctival inflammation and anatomical and immunological changes of the cornea.
Early stages OCP patients were identified, and Schirmer test, fluorescein and lissamine green staining, tear break-up time, and impression cytology of the conjunctiva were performed in 8 patients and in 8 age-matched controls. HLA-DR and CD45 expression on conjunctival cells was measured 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.
Statistically significant changes in corneal fluorescein staining (p<0.005), lissamine green conjunctival staining (p<0.005), HLA-DR expression (p<0.005) and CD45 (p<0.005) occurred in the study group compared to controls, while tear secretion did not show any differences. In patients with OCP confocal microscopy images obtained showed a significant lower number of epithelial cells (1238 ± 375 cc/mm2) compared to controls (1691 ± 190 cc/mm2, p<0.0001), superficial epithelial cell area considerably higher than normal, reduced nucleus/cytoplasm ratio, halos around the nuclei, and sharp borders. Numerous highly reflective dendritic-like cells were present in the epithelial cell basal layer, and their density correlated with HLA-DR expression. The stroma showed loss of keratocytes, the presence of lacunae, and tortuous subbasal nerves. No differences were recorded in endothelial cells density.
In OCP the ocular surface is characterized by inflammation of the conjunctiva 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.
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