Shruti Aggarwal1, Ahmad Kheirkhah2, Bernardo M Cavalcanti2, Andrea Cruzat3, Arsia Jamali4, Pedram Hamrah5. 1. Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Katzen Eye Group, Baltimore, MD, USA. 2. Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA. 3. Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Pontificia Universidad Catolica de Chile, Chile. 4. Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; New England Eye Center, and Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA. 5. Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; New England Eye Center, and Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA. Electronic address: pedram.hamrah@tufts.edu.
Abstract
PURPOSE: To evaluate corneal immune dendritiform cell (DC) changes in dry eye disease (DED) using in vivo confocal microscopy (IVCM) and to correlate IVCM parameters with clinical severity. METHODS: This was a retrospective, cross-sectional study including 300 eyes of 150 DED patients and 49 eyes of 49 age-matched controls. Severity of DED was based on the Dry Eye Workshop (DEWS) classification. IVCM images of subbasal layer of the central cornea were analyzed for DC density and morphology (including number of dendrites per DC, DC size and DC field). RESULTS: DC density was significantly higher in DED compared to controls (93.4 ± 6.3 vs. 25.9 ± 3.9 cells/mm2; P < 0.001). Morphologically, number of dendrites, DC size and field were significantly larger in DED (3.3 ± 0.1, 106.9 ± 4.7 μm2, 403.8 ± 20.1 μm2 than controls (2.3 ± 0.1, 62.5 ± 5.7 μm2, 241.4 ± 24.4 μm2, P < 0.001). Significantly higher DC density compared to controls was observed as early as Level 1 DED severity (87 ± 10 cells/mm2, p < 0.001. Significant morphological changes in DC were detected for Levels 2 to 4 (p=<0.001, and p =< 0.05) for dendrites and DC field, respectively. Similarly, DC size showed significant increase at DED level 3-4. (p < 0.05). Linear regression analysis showed that both conjunctival and corneal staining were independently associated with DC density, while corneal staining was independently associated with DC morphology. CONCLUSION: DC density and morphology correlated with clinical severity of DED. While, DC density is increased in mild DED, morphological changes are seen only in severe cases. IVCM may be a powerful tool to detect early immune changes and may complement clinical examination in DED.
PURPOSE: To evaluate corneal immune dendritiform cell (DC) changes in dry eye disease (DED) using in vivo confocal microscopy (IVCM) and to correlate IVCM parameters with clinical severity. METHODS: This was a retrospective, cross-sectional study including 300 eyes of 150 DED patients and 49 eyes of 49 age-matched controls. Severity of DED was based on the Dry Eye Workshop (DEWS) classification. IVCM images of subbasal layer of the central cornea were analyzed for DC density and morphology (including number of dendrites per DC, DC size and DC field). RESULTS: DC density was significantly higher in DED compared to controls (93.4 ± 6.3 vs. 25.9 ± 3.9 cells/mm2; P < 0.001). Morphologically, number of dendrites, DC size and field were significantly larger in DED (3.3 ± 0.1, 106.9 ± 4.7 μm2, 403.8 ± 20.1 μm2 than controls (2.3 ± 0.1, 62.5 ± 5.7 μm2, 241.4 ± 24.4 μm2, P < 0.001). Significantly higher DC density compared to controls was observed as early as Level 1 DED severity (87 ± 10 cells/mm2, p < 0.001. Significant morphological changes in DC were detected for Levels 2 to 4 (p=<0.001, and p =< 0.05) for dendrites and DC field, respectively. Similarly, DC size showed significant increase at DED level 3-4. (p < 0.05). Linear regression analysis showed that both conjunctival and corneal staining were independently associated with DC density, while corneal staining was independently associated with DC morphology. CONCLUSION: DC density and morphology correlated with clinical severity of DED. While, DC density is increased in mild DED, morphological changes are seen only in severe cases. IVCM may be a powerful tool to detect early immune changes and may complement clinical examination in DED.
Authors: David A Sullivan; Katherine M Hammitt; Debra A Schaumberg; Benjamin D Sullivan; Carolyn G Begley; Per Gjorstrup; Jean-Sébastien Garrigue; Masatsugu Nakamura; Yann Quentric; Stefano Barabino; Michelle Dalton; Gary D Novack Journal: Ocul Surf Date: 2012-02-08 Impact factor: 5.033
Authors: László Marsovszky; Miklós D Resch; János Németh; Gergely Toldi; Erzsébet Medgyesi; László Kovács; Attila Balog Journal: Innate Immun Date: 2012-11-30 Impact factor: 2.680
Authors: Federica Villanova; Paola Di Meglio; Margaret Inokuma; Nima Aghaeepour; Esperanza Perucha; Jennifer Mollon; Laurel Nomura; Maria Hernandez-Fuentes; Andrew Cope; A Toby Prevost; Susanne Heck; Vernon Maino; Graham Lord; Ryan R Brinkman; Frank O Nestle Journal: PLoS One Date: 2013-07-03 Impact factor: 3.240