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Adam Tanaka, zeina salem, Gabriela Dieckmann, Paula Kataguiri, Shruti Aggarwal, Rodrigo T Muller, Bernardo Cavalcanti, Andrea Cruzat, Ahmad Kheirkhah, Pedram Hamrah; In Vivo Confocal Microscopy in Patients with Dry Eye Disease Demonstrates Decreased Peripheral Corneal Nerve Density and Correlation to Clinical Signs. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3753.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the peripheral corneal nerve alterations in patients with dry eye disease (DED) as correlated to clinical signs and symptoms.
This is a prospective, cross-sectional, cohort study of 46 patients with DED. In vivo confocal microscopy (IVCM) images were taken for the central cornea and 4 peripheral quadrants. Images were analyzed for main trunk, branch and total nerve densities (mm/mm2) in a masked fashion. Clinical symptoms and signs were assessed using Ocular Surface Disease Index (OSDI), corneal (CFS) and conjunctival lissamine green staining (LGS), Schirmer’s test, and tear break-up time (TBUT), and correlated to IVCM parameters. A P value of <0.05 was considered statistically significant.
The mean symptoms score was 46.29±28.61. Mean TBUT was 2.78±2.08”, mean CFS was 3.91±3.12, mean LGS was 4.37±2.88, and mean Schirmer’s score was 12.83±10.50 mm. The mean peripheral nerve densities ranged 11.26±5.98 to 14.76±7.60 for total nerves, 1.87±1.02 to 2.10±1.80 for main trunks, and 7.09±3.92 and 9.14±4.77 for branches. CFS correlated with total nerve density in the nasal, temporal, superior and inferior quadrants (P<0.001; r=-0.42, r=-0.39, r=-0.36, r=-0.47), main trunk density (P<0.01; r=-0.36, r=-0.37, r=-0.33, r=-0.39), and branch nerve density (P<0.01; r=-0.40, r= -0.39, r=-0.29, r=-0.43). LGS also correlated with total nerve density in the nasal, temporal and inferior quadrants (P<0.01, r=-0.40, r=-0.34, r=-0.34), main trunk density (P<0.01, r=-0.39, r=-0.44, r=-0.35), and branch nerve density (P<0.05, r=-0.38, r=-0.43, r=-0.43). TBUT correlated with total nerve density in nasal, temporal, superior and inferior (P<0.05, r=0.57, r=0.40, r=0.50, r=0.58), main trunk density (P<0.001, r=0.52, r=0.55, r=0.51, r=0.57) and branch nerve density (P<0.01, r=0.51, r=0.47, r=0.38, r=0.50). No significant correlation was found between peripheral corneal nerve density and OSDI scores.
Patients with DED demonstrate a significant reduction of peripheral corneal nerve density, which correlates to dry eye signs. Dry eye symptoms did not show significant correlation to IVCM parameters.
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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