Abstract
Purpose :
Squamous metaplasia resulting from disturbances in epithelial differentiation has already been reported in dry eye patients. With an attempt to clarify the pharmacological effects of 2% rebamipide eye drops on the mucosal membrane functions of the ocular surface epithelium, we investigated the keratoconjunctival alterations at the cellular level in this study.
Methods :
Fifteen patients with definite dry eye disease according to Japanese Dry eye Research Society Diagnostic Criteria (1 male, 14 females; mean age: 64.9 years) were recruited from the outpatient clinic of Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital between June 2016 and March 2017. The patients received treatment with 2% rebamipide eye drops q.i.d for 12 weeks. Symptom score assessment, tear film break up time measurements, fluorescein and lissamine green ocular surface vital stainings, grading of lid wiper epitheliopathy, Cochet Bonnet corneal sensitivity, assessment of squamous metaplasia grades and goblet cell density calculations from conjunctival impression cytology samples as well as evaluation of nucleocytoplasmic ratios, corneal epithelial cell and nerve densities from in vivo confocal microscopy images before and 3 months after treatment were performed.
Results :
The mean symptom scores, tear film break up time values, ocular surface fluorescein and lissamine green vital staining scores and lid wiper scores showed a significant improvement after treatment (p=0.001). The mean squamous metaplasia grade also showed a significant improvement (1.2±0.1→0.3±0.1) three months after treatment (p=0.004). There were similar significant improvements in the mean corneal epithelial cell density (660.1±62.6→1015.5±43.5cells/mm2)(p=0.002) and nucleocytoplasmic ratios（0.1±0.0→0.2±0.0） (p=0.0042) after treatment. Wilcoxon test was used for statistical analyses.
Conclusions :
Topical use of 2% rebamipide drops for three months was associated with improvements in the ocular surface differentiation due to changes of mucosal functions at the cellular level. These alterations may explain the objective and subjective improvements in dry eye disease.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.