In-Vivo Confocal Microscopy Deep-Learning Based Analysis of the Subbasal Corneal Nerve Parameters of the Inferior Whorl in Dry Eye Disease, Neuropathic Corneal Pain, and Controls.

Abstract

Purpose : Use of a novel machine learning algorithm for the un-biased evaluation of in-vivo confocal microscopy (IVCM) images of corneal nerves in patients with dry eye disease (DED) and neuropathic corneal pain (NCP).

Methods : Corneal subbasal nerve plexus (SNP) images of the inferior whorl of patients with DED (n = 49, 77 eyes), NCP (n = 14, 24 eyes), and controls (n = 41, 59 eyes) were taken with in-vivo confocal microscopy (IVCM). The images were analyzed using an artificial intelligence (AI)-based algorithm previously developed by our group (Zemborain ZZ, et al. 2023). This is a two-step algorithm that (1) segments and removes applanation artifacts and (2) segments nerves, immune cells, and neuromas in the SNP. The following parameters were compared between groups: nerve density, average nerve thickness, average nerve segment tortuosity, junction point density, neuroma density, and immune cell density.

Results : 160 eyes of 104 patients (63% females), were included. The mean age at presentation was 57 + 15 years. Fourteen (14%) patients had Sjögren syndrome (SS) and 15 (14%) ocular graft-versus-host disease (oGVHD). While the mean nerve density of the control group was significantly higher compared with the DED (P = 0.012) and NCP (P < 0.001) groups, the junction point density was lower in the NP group compared to the DED (P = 0.004) and control (P = 0.001) group. The immune cell density was higher in the DED group compared with controls (P < 0.001). Sub-analysis showed that eyes with oGVHD- and SS-associated DED had a higher immune cell density compared to those with idiopathic DED (P = 0.006 and P = 0.054, respectively).

Conclusions : Deep-learning based analysis of IVCM images of the corneal SNP inferior whorl distinguished a decrease mean nerve density in patients with DED and NCP compared with controls, and an increase immune cell density in patients with oGVHD- and SS-associated DED. These findings suggest that the inferior whorl could be used as a landmark to distinguish between patients with DED and NCP.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.