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H. Lin, Z. Liu; In vivo Laser Confocal Microscopic Investigation of Cornea in Aqueous Tear Deficiency. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5313. doi: https://doi.org/.
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To investigate the in vivo microstructure, especially concerning the density and distribution of Langerhans cell, the occurrence rate of leucocyte, and the properties of subbasal nerve plexus, in the cornea of aqueous tear deficiency patients.
A cornea-specific in vivo laser scanning confocal microscope (Heidelberg Retina Tomograph 3 Rostock Cornea Module, HRT3-RCM) was used. In this study, a total of 50 eyes of 41 patients were investigated. Group 1 (normal eyes) included 12 eyes of 12 healthy volunteers, group 2 included 38 eyes of 36 patients affected by aqueous tear deficiency (4 Sjogren syndrome and 32 non-Sjogren syndrome). Confocal microscope images were taken at the central, at the upper and temporal sides of intermediate and periphery cornea. Quantitative and morphological assessments of the Langerhans cells, of the leucocyte and the subbasal nerve plexus were made. These data were correlated with age and the degree of dry eye.
Langerhans cells were visualized in the basal epithelial layer, basal lamina and the subbasal nerve plexus in both groups. In group 1, the limbal, the intermediated and the central cornea epithelium demonstrated Langerhans cells in 92%, 67%, and 20% respectively. In group 2, as for SS and non-SS patients, Langerhans cells presenting rates in the limbal, the intermediated, and the central cornea were all 100%. The density of Langerhans cells in group 2 were significantly increased compared with group 1 in each site (P<0.01). SS patients had higher density of Langerhans cells than non-SS ones.Besides, SS patients had more mature Langerhans cells in the central cornea. Leucocytes can be found in 89% individuals in group 2, while none in group 1. Severe nerve tortuosity, beading, and branching appeared more frequently in aqueous tear deficiency than in normal subjects, especially in the SS patients. Corneal fluorescein staining score was positively correlated with the density of Langerhans cells and the nerve abnormal findings.
Dry eye patients showed significant alterations in the distribution and density of Langerhans cells, the occurrence rate of leucocytes, as well as the morphologic changes of subbasal nerve plexus.
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