Ocular Microbiology and Immunology Group
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2013 OMIG Abstract 23

Clinical Severity of Dry Eye Disease Correlates with Corneal Immune Cell Alterations as Detected by In Vivo Confocal Microscopy
Ahmad Kheirkhah, MD, Shruti Aggarwal, MD, Bernardo M Cavalcanti, MD, Pedram Hamrah, MD.
Ocular Surface Imaging Center, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA

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. Therefore, the purpose of this study 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 the control group (26.0 ± 3.7 cell/mm²), significant increases in corneal DC density were observed in all levels of DED (P<0.001), with 87.2 ± 10.4 cell/mm² in level 1 (mild), 92.9 ± 9.6 cell/mm² in level 2 (moderate), 105.8 ± 18 cell/mm² in level 3 (severe), and 95.8 ± 20.32 cell/mm² in level 4 (severe). 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 (63.8 ± 4.1 µm², 2.9 ± 0.1 per DC, 247.5 ± 22.8 µm², respectively) and level 1 (mild) DED (90.2 ± 3.7 µm², 3.03 ± 0.1 per DC, 319.8 ± 20.7 µm², respectively). However, these morphologic parameters showed statistically significant increases in DED levels 2-4 compared with the controls (P<0.05).

Conclusions: 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.

Financial Support: Funding: NIH K08-EY020575 (PH), Falk Medical Research Foundation (PH) and Allergan, Inc., Irvine, CA, USA
AAO Disclosure Code: Kheirkhah (N), Aggarwal (N), Cavalcanti (N), Hamrah (C, S).

2013 Agenda and Abstracts | < Previous | Next >