Patients with post-surgical dry eye disease demonstrate decreased corneal nerve density and increased density of dendritiform cells by in vivo confocal microscopy compared to non-surgical dry eye patients

Abstract

Purpose : Patients with dry eye disease (DED) can occur due to surgical events. However, an investigation into post-surgical DED and DED not due to surgery and their findings via in vivo confocal microscopy (IVCM) have yet to be conducted. This study aims to assess if IVCM differences exist in patients who associate the onset of their symptoms with an ocular surgery compared to those who did not.

Methods : This retrospective cross-sectional cohort study included DED, classified based on whether they reported symptom onset associated with ocular surgery (Sx DED) or not (DED). ImageJ/NeuronJ were used to quantify three images for dendritiform cells (DCs) and nerve parameters. DC parameters included DC density, average DC size, and number of dendrites per DC based. Nerve quantification included total, main and branch nerve densities. These IVCM parameters were compared between the groups along with ocular pain assessment survey (OPAS) and ocular surface disease index (OSDI) questionnaire data.

Results : The age and sex distributions between the Sx DED group (n=32; age med: 67.8 (IQR: 32.0]; 75% female) and DED group (n=197; age med: 57.8 [IQR: 24.0]; 78.1% female) was not different (p=0.061 and p=0.700, respectively). The total and main nerve densities were lower in Sx DED patients (11,341.31±952.78 µm/mm2 and 7,269.87±509.34, respectively compared to DED patients (13,751.81±350.05 µm/mm2, p=0.012 and 8,810.91±204.69, p=0.005, respectively). This was not true for branch nerve density (Sx DED: 4,071.44±531.67 µm/mm2; DED: 4940.90±212.34; p=0.128). The DC density was higher in the Sx DED group (med: 59.38/mm2 [IQR: 47.40]) compared to the DED group (med: 31.25/mm2 [IQR: 68.75]; p=0.047). But there was no significant difference in average DC size (Sx DED med: 89.60µm2 [IQR: 52.35]; DED med: 90.66 [IQR: 68.90]; p=0.732) or number of dendrites per DC (Sx DED med: 0.50 [IQR: 0.56]; DED med: 0.40 [IQR: 1.0]; p=0.823). Analysis of symptoms and signs did not show any significant difference between the groups (all p>0.05).

Conclusions : Reduced nerve density and increased DC density in Sx DED suggests more profound pathological changes in this group. This could indicate the need for more aggressive treatment in this group.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.