Corneal In Vivo Confocal Microscopy in Ocular Graft versus Host Disease

Abstract

Purpose : To compare the density of corneal immune cells and nerves in patients with dry eye disease (DED) with and without ocular graft versus host disease (GVHD) using in vivo confocal microscopy (IVCM).

Methods : This retrospective study included 54 patients who had DED with (n=33) or without (n=21) ocular GVHD. All had moderate to severe DED, an Ocular Surface Disease Index (OSDI) score >22 and corneal fluorescein staining (CFS) score ≥4/15 (National Eye institute; NEI scale). All had a complete ophthalmic evaluation, which consisted of symptom questionnaires (including OSDI and Symptom Assessment iN Dry Eye [SANDE]) and clinical assessment including CFS, conjunctival lissamine green staining, tear break-up time (TBUT), and Schirmer’s test. All patients also had laser-scanning IVCM (Heidelberg Retina Tomograph 3, Heidelberg, Germany) of the central cornea and superior palpebral conjunctiva. The densities of the following cells were measured in IVCM images using ImageJ software by two masked observers: corneal subbasal immune dendritic cells (DC), corneal subbasal nerve fibers, and conjunctival epithelial inflammatory cells.

Results : There were no significant differences between the GVHD and non-GVHD groups in terms of age or gender. There were no significant differences between GVHD and non-GVHD groups in OSDI (57.9 ± 20.5 and 53.8 ± 21.0, respectively, P=0.49) and SANDE (63.1 ± 19.1 and 69.7 ± 16.9, respectively, P=0.36). However, the GVHD group had significantly worse CFS (7.1±2.4 vs 5.4±1.8, P=0.01), TBUT (2.4±1.8 vs 4.3±1.9 seconds, P=0.001), and Schirmer scores (3.9±4.3 vs 7.6±6.8 mm, P=0.01) compared to the non-GVHD group. In IVCM images, corneal DC density, corneal subbasal nerve fiber density, and conjunctival epithelial inflammatory cell density were 148±135 cells/mm², 16.3±6.1 mm/mm² and 670±267 cells/mm² in the GVHD group and 122 ± 99 cells/mm², 18.3 ± 5.1 mm/mm² and 572 ± 271 cells/mm² in the non-GVHD group. After adjusting for DED severity, none of the IVCM parameter was significantly different between the groups (P=0.41, P=0.21 and P=0.20 respectively).

Conclusions : After adjusting for DED severity, cell densities assessed by IVCM are similar in patients with DED with or without ocular GVHD. Therefore, the corneal and conjunctival IVCM findings in ocular GVHD may solely be due to DED and not the underlying disease.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.