Effect of Topical Cyclosporine on Corneal Dendritic Cell Density in Dry Eye Syndrome Using In Vivo Confocal Microscopy

Abstract

Purpose : Dry Eye Syndrome is associated with increased corneal dendritic cell (DC) density, which correlates with greater subjective dry eye symptoms. This retrospective study investigated the effects of cyclosporine eye drops on corneal DC density using in vivo confocal microscopy. Our hypothesis is that cyclosporine will reduce inflammation, marked by decreased DC density.

Methods : IVCM images of central corneas for dry eye patients were obtained with Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany). The study included patients older than 18 years who demonstrated dry eyes through slit lamp exam or tear break-up time less than 5 seconds. Exclusion criterion was topical steroid usage. Images were taken prior to and three months after treatment with either cyclosporine 0.05% or 0.09% twice daily in both eyes. Corneal images were analyzed for dendritic cells (DCs) in the sub-basal nerve plexus. A student t-test was used to compare DC density before and after treatment.

Results : 20 eyes of 10 patients (7 women; mean age 56 ± 22 years) completed the study. 16 eyes and 4 eyes were treated with cyclosporine 0.05% and 0.09% respectively. One eye was excluded due to poor image quality. Mean DC density was 64.63 ± 81.48 cells/mm² at baseline and 50.36 ± 61.86 cells/mm² after three months of treatment. There was an average DC density decrease of 14.26 ± 44.95 cells/mm². 12 eyes showed decreased DC density and 7 eyes showed no notable change or increased density. For eyes treated with cyclosporine 0.05% and 0.09%, the mean difference between baseline and post-intervention was a decrease of 3.00 ± 25.56 cells/mm² (p=0.92) and 56.50 ± 77.87 cells/mm² (p=0.24) respectively.

Conclusions : Topical cyclosporine is known to be effective in treating DES, but its microstructural effects on ocular surface inflammation have not been quantified. In this study, IVCM was utilized to quantify cyclosporine’s effects on reducing corneal DC density in dry eyes. Further investigation is necessary to elucidate this potentially dose-related effect.

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

 

Left: DES cornea before treatment with a high density of dendritic cells.
Right: DES cornea after 3 months of treatment with cyclosporine 0.09%. Fewer dendritic cells are noted.

 

Time vs. Dendritic Cell Density for treatment with cyclosporine 0.05% (left) and cyclosporine 0.09% (right)