Abstract
Purpose :
To compare corneal nerve alterations in patients with neuropathic corneal pain (NCP) and positive serology for autoimmune antibodies (Ab) with and without IgM against neuronal trisulfated heparin disaccharide (TS-HDS) and IgG against fibroblast growth factor receptor 3 (FGFR3).
Methods :
Retrospective chart review of NCP patients (n=35) with autoimmune Ab (those having a positive result for ANA, SS-A, SS-B, c-ANCA, p-ANCA, anti-gliadin IgA, anti-TS-HDS IgM and/or anti-FGFR3 IgG were included in the study). Laser in vivo confocal microscopy (HRT3/RCM) images were analyzed using corneal nerve alterations using Neuron J in a masked fashion, comparing patients with or without anti-neuronal TS-HDS IgM/FGFR-3 IgG. The control group consisted of age- and sex-matched subjects (n=35) from a reference normative database.
Results :
The mean age was 50.3±19.0(20-88) years for patients without anti-neuronal Abs (n=19, 4 males, 15 females) and 48.1±18.7(27-74) years for patients with anti-neuronal Abs (n=16, 1 male, 15 females), and 47.5+13.5(27-74) years (n=35, 5 males, 30 female) for controls. The overall pain intensity in the anti-TS-HDS IgM/FGFR-3 IgG (+) group was 5.67±2.99 (1.0-10.0) and similar to 5.20±2.26 (1.0-10.0) in the anti-TS-HDS IgM /FGFR-3 IgG (-) group (p=0.66). The mean total, main and branch subbasal corneal nerve densities in patients with anti-TS-HDS IgM/FGFR-3 IgG were 9,944.7±1,085.0 mm/mm2, 6,542.7 ± 563.2, and 3,402.0±579.2, and were significantly lower (p=0.01, p=0.01, p=0.03 respectively) compared to patients without anti-neuronal Abs with 14,406.7±1,192.1, 9,046.2±684.8, and 5,360.6±592.9, and controls (20,896.0±697.4, 9,097.4±460.6, and 11,778.6±564.4, p=0.001, p=0.005, p<0.001 respectively). The number of mean total and branch subbasal corneal nerves in patients with or without anti-TS-HDS IgM/FGFR-3 IgG were significantly lower compared to healthy controls (p<0.001). The number of mean main subbasal corneal nerves was lower in patients with anti-neuronal Abs compared to anti-TS-HDS IgM/FGFR-3 IgG (-), (p=0.07).
Conclusions :
NCP patients with autoimmune conditions demonstrate reduced nerve density compared to controls. NCP patients with anti-neuronal TS-HDS IgM and/or FGFR-3 IgG demonstrate significant corneal nerve fiber loss compared to other autoimmune-mediated NCP patients.
This is a 2021 ARVO Annual Meeting abstract.