Journal List > J Korean Ophthalmol Soc > v.56(5) > 1010266

Choi, Kim, Seo, Kim, and Lee: Corneal Microstructural Changes in Non-Sjögren Dry Eye Using Confocal Microscopy: Clinical Correlation

초록

Purpose:

To investigate the relationship between changes of corneal epithelium and subbasal nerves in non-Sjögren dry eye using in vivo confocal microscope (IVCM) and self-reported clinical symptoms.

Methods:

The present study included 40 patients with dry eye and 18 healthy control subjects. The dry eye group underwent an evaluation of dry eye symptoms using visual analogue scale (VAS) score and was subdivided into 2 groups; score 0-5 as the low VAS score (LVS) group and score 6 - 10 as the high VAS score (HVS) group. The tear film break-up time, fluorescein staining, Schirmer test and microstructural imaging of epithelium, and subbasal nerve at cornea center with IVCM were performed on both eyes of each patient. Twenty-three normal eyes and 54 eyes of dry eye patients were included in the study. Cell densities and morphological characteristics were analyzed using ImageJ and NeuronJ softwares.

Results:

Both LVS and HVS groups had decreased cell density of superficial, intermediate, and basal epithelium ( p < 0.001). Intermediate epithelial cells were more decreased in the dry eye group with more severe symptoms ( p < 0.0001). Subbasal nerve density ( p < 0.005) was more decreased and nerve beadings, tortuosity, and reflectivity increased in the HVS group than both LVS and control groups ( p < 0.05).

Conclusions:

The alterations of corneal cellular level in dry eye patients visualized using IVCM are correlated with pathology and clinical symptoms and may be useful objective criteria in diagnosis and monitoring treatment efficacy.

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Figure 1.
In vivo confocal images of cornea. Superficial epithelium. Compared with (A), (B), and (C) had more decreased cell density. (A) Showing regularly arranged cells with dark nuclei. (B) and (C) showing squamous metaplasia, hyperreflectivity as compared to control. Intermediate epithelium. Compared with (D) and (E), (F) had more decreased cell density. Basal epithelium. Compared with (G), (H) and (I) had more decreased cell density. Bar, 100 μ m. LVS = low visual analogue scale score; HVS = high visual analogue scale score.
jkos-56-680f1.tif
Figure 2.
In vivo confocal images of cornea. Subbasal nerve. Compared with (A) and (B), (C) had more decreased subbasal nerve density and had more increased subbasal nerve beadings, tortuosity, and reflectivity. Bar, 100 μ m. LVS = low visual analogue scale score; HVS = high visual analogue scale score.
jkos-56-680f2.tif
Table 1.
Demographic data and clinical test results
  Control LVS HVS p-value
Eyes (n) 23 26 28 N/A
Age (years) 47.87 ± 15.93 54.39 ± 11.28 50.38 ± 15.62 0.37
Sex (M/F) 7/11 4/16 9/11 0.53
BCVA (log MAR) 0.02 ± 0.07 0.03 ± 0.08 0.02 ± 0.05 0.21
Duration of dry eye (months)   41.78 ± 52.76 27.11 ± 26.44 0.32
Time of treatment (months)   18.40 ± 23.06 15.28 ± 19.37 0.67
Schirmer test (mm/5 min) 12.8 ± 2.50 6.00 ± 1.41 5.13 ± 0.89 <0.001*,; 0.44
FTBUT (s) 7.5 ± 2.64 3.00 ± 0.69 1.94 ± 1.00 <0.001*,, <0.05
Oxford scheme grade 0.13 ± 0.34 1.61 ± 1.24 1.94 ± 0.92 0.06*, <0.05, 0.14
VAS score 0.17 ± 0.49 2.56 ± 1.42 7.25 ± 1.00 <0.001*,,

Values are presented as mean ± SD unless otherwise indicated; Data in parentheses are 95% confidence interval; p-value is by ANOVA.

LVS = low VAS score; HVS = high VAS score; N/A = not applicable; BCVA = best corrected visual acuity; FTBUT = fluorescein tear breakup time; VAS = visual analogue scale; ANOVA = analysis of variance.

* Control vs. LVS;

Control vs. HVS;

LVS vs. HVS.

Table 2.
Cell densities of corneal superficial, intermediate, and basal epithelium by IVCM analysis
  Epithelium
superficial (cells/mm²) Intermediate (cells/mm²) Basal (cells/mm²)
Control 1,234 ± 149 6,931 ± 126 11,478 ± 586
LVS 864 ± 51 5,832 ± 232 9,023 ± 222
HVS 789 ± 31 5,316 ± 265 8,688 ± 209
p-value <0.001*,; 0.17 <0.0001*,, <0.001*,; 0.06

Values are presented as mean ± SD; Data in parentheses are 95% confidence interval; p-value is by ANOVA.

IVCM = in vivo confocal microscope; LVS = low visual analogue scale score; HVS = high visual analogue scale score; ANOVA = analysis of variance.

* Control vs. LVS;

Control vs. HVS;

LVS vs. HVS.

Table 3.
Density and morphological characteristics of corneal subbasal nerve by IVCM analysis
  Subbasal nerve
Density (μ m/mm²) Beading (No./mm) Tourtuosity (grade, 0-4) Reflectivity (grade, 0-4)
Control 12,030.05 ± 2,203.55 178.70 ± 27.39 1.6 ± 0.6 2.3 ± 0.6
LVS 10,434.00 ± 2,347.73 302.72 ± 18.04 3.0 ± 0.6 2.8 ± 0.5
HVS 9,884.56 ± 2,548.56 329.38 ± 24.13 3.7 ± 0.5 3.0 ± 0.4
p-value <0.005*,, <0.001*,; <0.01 <0.001*,; <0.05 <0.05*,; 0.72

Values are presented as mean ± SD; Data in parentheses are 95% confidence interval; p-value is by ANOVA.

IVCM = in vivo confocal microscope; LVS = low visual analogue scale score; HVS = high visual analogue scale score.

* Control vs. LVS;

Control vs. HVS;

LVS vs. HVS.

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