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Paula Kataguiri, Gabriela Dieckmann, Shruti Aggarwal, Rodrigo T Muller, Bernardo Cavalcanti, Yureeda Qazi, Andrea Cruzat, Ahmad Kheirkhah, Pedram Hamrah; Clinical Signs of Dry Eye Disease are Correlated to Peripheral Corneal Immune Cell Alterations by In Vivo Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2664. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Inflammation has been recognized to play a major role in the pathogenesis of dry eye disease (DED). In vivo confocal microscopy (IVCM) is a sensitive tool for detecting subclinical inflammation. In this study, we aimed to assess epithelial corneal dendritiform immune cell (DC) alterations in the peripheral cornea of patients with DED and to correlate these to clinical signs and symptoms.
This is a prospective, cross-sectional, cohort study of 46 patients with DED. Corneal IVCM images were in all 4 peripheral quadrants. Three representative images were analyzed for DC density and morphology (DC area and DC field) by two masked observers and correlated to ocular surface disease index (OSDI), corneal (CFS) and conjunctival staining (CS; NEI scales), Schirmer’s test and tear break-up time (TBUT). DED severity (1-4) was based on Dry Eye Workshop (DEWS). P value <0.05 was considered statistically significant.
The mean symptom score was 46.2±28.6 for OSDI. Mean signs were 3.9±3.1 for CFS, 4.3±2.8 for CS, 2.7±2 seconds for TBUT, and 12.8±10.5 mm for Schirmer’s test. DC density, area and field in the peripheral corneal quadrants ranged from 49.2±49.1 to 84.7±77.7 cells/mm2, 145.8±52.1 to 150.9±62.7m2 and 208.5±115.3 to 351.9±286.5m2. In the nasal quadrant, there was a correlation between DC density and CFS (p=0.001, R=0.40), and DC density and TBUT (p=0.03, R=-0.28); in the temporal quadrant, correlation was found between DC density and CFS (p=0.008, R=0.4), DC density and CS (p=0.015, R=0.3), and DC density and TBUT (p=0.009, R=-0.34). For the superior cornea, DC field correlated with TBUT (p=0.001, R=-0.49), and CS (p=0.02, R=0.29) and DC density correlated with the CS (p=0.048, R=0.24). Finally, for inferior quadrant, DC density correlated with TBUT (p=0.004, R=-0.37), CFS (p=0.006, R=0.33) and CS (p=0.04, R=0.35). No statistical difference was found comparing IVCM findings in relation to OSDI or DED severity level.
This study demonstrates a correlation between peripheral corneal IVCM findings and clinical signs, in particular for the nasal and temporal quadrants as early as in DEWS grade 1. No statistical difference was found comparing IVCM findings with DED severity level or symptoms. Reversal of these differential changes may be used to evaluate efficacy of anti-inflammatory DED treatment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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