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Adrian C Tsang, Jeremy Nortey, Sarah E Lopez, John Alexander Gonzales, Jeremy D Keenan; Evaluating the Qualitative Features of Occular Surface Dry Eye Disease using a Novel Confocal Microscopy Imaging Protocol. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1229 – A0229.
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© ARVO (1962-2015); The Authors (2016-present)
To examine differences of the corneal sub-basal nerve plexus between participants from the Sjogren’s International Collaborative Clinical Alliance (SICCA) and healthy controls based on qualitative features of nerve tortuosity, and the presence of nerve sprouts and dendritic cells.
Cross-sectional study in which participants from SICCA were recalled for follow-up and age-matched healthy controls were recruited. All participants had in vivo confocal microscopy (Heidelberg Rostock, Heidelberg, Germany) of the central sub-basal nerve plexus centered about the central vortex, yielding a montage image comprised of 30 images. Each image was then assessed by 3 masked graders for 3 features: presence of nerve tortuosity, presence of neuromas, and number of dendritic cells.The majority consensus grade between the 3 graders was calculated for each image, and then the fraction of images per eye with the finding was calculated as a score indicating the proportion of images per eye displaying the given feature.
A total of 774 confocal images from 26 eyes (15 from SICCA participants and 11 control eyes) were reviewed by the 3 graders, with each eye contributing between 25-30 scans. The mean tortuosity score was 40 (SD 27) in the SICCA participant group and 2 (SD 2) in the control group (P<0.001, Wilcoxon rank sum test); the mean nerve sprout score was 18 (SD 15) in the SICCA participant group and 2 (SD 2) in the control group (P=0.04); and the mean dendritic cell score was 44 (SD 29) in the SICCA participant group and 32 (SD 27) in the control group (P=0.30).
The presence of tortuosity and nerve sprouts on in vivo corneal confocal microscopy were significantly different between SICCA participants and healthy controls. There was no significant difference in the amount of dendritic cells between SICCA participants and healthy controls. Our novel imaging protocol can be used to standardize the qualitative evaluation of the corneal sub-basal nerve plexus and the presence of tortuosity and nerve sprouts may be used to differentiate between patients with and without Sjogren’s dry eye. Standardized evaluation of the corneal sub-basal nerve plexus may have future applications in the diagnostic criteria for Sjogren’s disease and help bring clarity in both the research realm and in the direct care of these patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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