Ocular Microbiology and Immunology Group
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2023 OMIG Abstract

Patients with Neurotrophic Keratopathy Demonstrate Increased Dendritiform Cell Density and Size by in vivo Confocal Microscopy, Suggesting the Presence of Inflammation

Ana Balbuena-Pareja¹, Luiz Lamazales¹, Chloe Bogen¹, Anupa Thirmiya¹, and Pedram Hamrah<sup>1,2

1</sup>Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,
Tufts University School of Medicine, Boston, MA; ²Cornea Service, New England Eye Center,
Tufts Medical Center, Boston, MA

Purpose: Corneal dendritic cells (DC) have a role in corneal immune surveillance and an increased size of DC have been considered to be an indicator for their activation. DC activation has been associated with progression and severity of inflammatory corneal diseases. Neurotrophic keratopathy (NK) is a neurodegenerative disease that affects corneal nerves. However, DC changes have not been assessed in NK to date. Thus, we aim to determine corneal DC density and size by in vivo confocal microscopy (IVCM) in patients with NK and to correlate corneal nerve densities with dendritic cell changes in stage 1 and 2 neurotrophic keratopathy patients.

Methods: This retrospective, cross-sectional study included NK1 and NK2 subjects who have not received systemic immunosuppressive treatment or topical steroids within one month. Three representative IVCM images were graded for nerve and DC density/size.

Results: The NK group (n=18, age 59.2±20.3yrs; 22.2% male) [NK1 (n=16), NK2 (n=2)] and control group (n=13, age 47.1±8.6yrs, 30.8% male) did not differ in age (p=0.06) or sex (p=0.59). Total, main, branch nerve densities [median (range) in mm/mm²] were lower in NK group [3.05 (0.00 - 12.55), 1.59 (0.00 - 7.02), 1.46 (0.00 - 5.53)] vs. controls [17.85(12.76 - 26.87); 8.33(5.42 -15.04); 8.12(3.22 - 16.38), respectively, (all p<0.001)]. DC density and DC size [median (range) in cells/mm² and µ², respectively] were higher in NK group 72.71 (2.08 - 392.71) and 179.06 (63.86 - 300.67) vs. controls 2.80 (0.70 - 6.80) (p=<0.001), and 77.50 (48.90 - 263.10) (p=0.002), respectively. DC size was correlated with total, main, and branch nerve density (r=-0.57, p=<0.001), (r=-0.50, p=0.004), (r=-0.48, p=0.007), respectively.

Conclusions: Increased DC density and activation in patients with NK1 and NK2 subjects suggests that inflammation may play a role in the pathogenesis of NK. Moreover, increased DC activation is correlated with decreased corneal nerve density in NK1 and NK2 patients.

Disclosure: N (Balbuena-Pareja, Lamazales, Bogen, Thirmia); S (Hamrah: Dompe, Noveome, Kala, Claris); C (Hamrah: Dompe, Kala, Amber)

Support: Dompe

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