Correlation of Clinical Severity of Dry-Eye Disease With Corneal Immune Cell Alterations Detected by in Vivo Confocal Microscopy

Aggarwal, Shruti

Correlation of Clinical Severity of Dry-Eye Disease With Corneal Immune Cell Alterations Detected by in Vivo Confocal Microscopy

Sunday, April 27, 2014: 1:48 PM

Room 150 (Boston Convention and Exhibition Center)

Shruti Aggarwal, MD, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

Ahmad Kheirkhah Boston, MA, USA

Bernardo M. Cavalcanti, MD, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

Pedram Hamrah, MD, Harvard Medical School/SERI/MEEI, Boston, Massachusetts, USA

Narrative Responses:

Purpose
Recent studies have shown the role of immune changes in the pathogenesis of dry eye disease (DED). Clinical examination alone cannot detect these immune changes in various levels of DED severity. The purpose is to evaluate the changes in corneal immune dendritic cells (DC) in different levels of DED severity.

Methods
This retrospective study included 150 patients with DED and 52 age-matched controls. The images obtained by in vivo confocal microscopy (IVCM) from central cornea were analyzed for DC density and morphology (cell size, number of dendrites, and DC field). Clinical severity of DED was graded (levels 1-4) based on Dry Eye Workshop (DEWS). Clinical severity of DED was then correlated with IVCM parameters.

Results
Compared with corneal DC density in controls (26.0 ± 3.7 cell/mm²), significant increases in DC density were observed in all levels of DED (P<0.001). The differences among corneal DC densities in various levels of DED were not statistically significant. In contrast to corneal DC density, in morphologic parameters there were no significant differences in DC size, number of dendrites and field area between the control group and level 1 DED. However, these morphologic parameters showed statistically significant increases in DED levels 2-4 compared with the controls (P<0.05).

Conclusion
While corneal DC density is increased in mild DED (level 1), DC morphological changes increase in more severe disease, signifying increased activation. These parameters may aid in therapeutical decision-making, and reversal of these differential changes may be used to evaluate the efficacy of anti-inflammatory treatment in DED.