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Tajbakhsh Z, Golebiowski B, Stapleton F, Alghamdi A, Gray PE, Altavilla B, Briggs N, Jalbert I. Increased dendritic cell density and altered morphology in allergic conjunctivitis. Eye (Lond) 2023; 37:2896-2904. [PMID: 36747109 PMCID: PMC10516863 DOI: 10.1038/s41433-023-02426-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Corneal and conjunctival epithelial dendritic cells (DC) have an established role in vernal keratoconjunctivitis, however, their role in more prevalent forms of allergic eye disease remains unclear. This study evaluated corneal and conjunctival epithelial DC density, morphology, and distribution observed using in vivo confocal microscopy (IVCM) in allergic conjunctivitis. METHODS In this prospective, observational study, 66 participants (mean age 36.6 ± 12.0 years, 56% female): 33 with allergic conjunctivitis and 33 controls were recruited. IVCM was performed at the corneal centre, inferior whorl, corneal periphery, corneal limbus, and temporal bulbar conjunctiva. DC were counted and their morphology was assessed as follows: largest cell body size, presence of dendrites, and presence of long and thick dendrites. Mixed model analysis (DC density) and non-parametric tests (DC morphology) were used. RESULTS DC density was higher in allergic participants at all locations (p ≤ 0.01), (corneal centre median (IQR) 21.9 (8.7-50.9) cells/mm2 vs 13.1 (2.8-22.8) cells/mm2; periphery 37.5 (15.6-67.2) cells/mm2 vs 20 (9.4-32.5) cells/mm2; limbus 75 (60-120) cells/mm2 vs 58.1 (44.4-66.2) cells/mm2; conjunctiva 10 (0-54.4) cells/mm2 vs 0.6 (0-5.6) cells/mm2, but not at the inferior whorl 21.9 (6.2-34.4) cells/mm2 vs 12.5 (1.9-37.5) cells/mm2, p = 0.20. At the corneal centre, allergic participants had larger DC bodies (p = 0.02), a higher proportion of DC with dendrites (p = 0.02) and long dendrites (p = 0.003) compared to controls. CONCLUSIONS Corneal and conjunctival DC density was increased, and morphology altered in allergic conjunctivitis. These findings imply that the ocular surface immune response was upregulated and support an increased antigen-capture capacity of DC in allergic conjunctivitis.
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Affiliation(s)
- Zahra Tajbakhsh
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | | | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Ali Alghamdi
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Paul E Gray
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Betina Altavilla
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, UNSW, Sydney, NSW, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
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Density and distribution of dendritiform cells in the peripheral cornea of healthy subjects using in vivo confocal microscopy. Ocul Surf 2022; 26:157-165. [PMID: 35998820 DOI: 10.1016/j.jtos.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To establish dendritiform cell (DC) density and morphological parameters in the central and peripheral cornea in a large healthy cohort, using in vivo confocal microscopy (IVCM). METHODS A prospective, cross-sectional, observational study was conducted in 85 healthy volunteers (n = 85 eyes). IVCM images of corneal center and four peripheral zones were analyzed for DC density and morphology to compare means and assess correlations (p < 0.05 being statistically significant). RESULTS Central cornea had lower DC density (40.83 ± 5.14 cells/mm2; mean ± SEM) as compared to peripheral cornea (75.42 ± 2.67 cells/mm2, p < 0.0001). Inferior and superior zones demonstrated higher DC density (105.01 ± 7.12 and 90.62 ± 4.62 cells/mm2) compared to the nasal and temporal zones (59.93 ± 3.42 and 51.77 ± 2.98 cells/mm2, p < 0.0001). Similarly, lower DC size, field and number of dendrites were observed in the central as compared to the average peripheral cornea (p < 0.0001), with highest values in the inferior zone (p < 0.001 for all, except p < 0.05 for number of dendrites in superior zone). DC parameters did not correlate with age or gender. Inter-observer reliability was 0.987 for DC density and 0.771-0.922 for morphology. CONCLUSION In healthy individuals, the peripheral cornea demonstrates higher DC density and larger morphology compared to the center, with highest values in the inferior zone. We provide the largest normative cohort for sub-stratified DC density and morphology, which can be used in future clinical trials to compare differential changes in diseased states. Furthermore, as DC parameters in the peripheral zones are dissimilar, random sampling of peripheral cornea may be inaccurate.
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Neuroimmune crosstalk in the cornea: The role of immune cells in corneal nerve maintenance during homeostasis and inflammation. Prog Retin Eye Res 2022; 91:101105. [PMID: 35868985 DOI: 10.1016/j.preteyeres.2022.101105] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/29/2022]
Abstract
In the cornea, resident immune cells are in close proximity to sensory nerves, consistent with their important roles in the maintenance of nerves in both homeostasis and inflammation. Using in vivo confocal microscopy in humans, and ex vivo immunostaining and fluorescent reporter mice to visualize corneal sensory nerves and immune cells, remarkable progress has been made to advance our understanding of the physical and functional interactions between corneal nerves and immune cells. In this review, we summarize and discuss recent studies relating to corneal immune cells and sensory nerves, and their interactions in health and disease. In particular, we consider how disrupted corneal nerve axons can induce immune cell activity, including in dendritic cells, macrophages and other infiltrating cells, directly and/or indirectly by releasing neuropeptides such as substance P and calcitonin gene-related peptide. We summarize growing evidence that the role of corneal intraepithelial immune cells is likely different in corneal wound healing versus other inflammatory-dominated conditions. The role of different types of macrophages is also discussed, including how stromal macrophages with anti-inflammatory phenotypes communicate with corneal nerves to provide neuroprotection, while macrophages with pro-inflammatory phenotypes, along with other infiltrating cells including neutrophils and CD4+ T cells, can be inhibitory to corneal re-innervation. Finally, this review considers the bidirectional interactions between corneal immune cells and corneal nerves, and how leveraging this interaction could represent a potential therapeutic approach for corneal neuropathy.
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Peil J, Bock F, Kiefer F, Schmidt R, Heindl LM, Cursiefen C, Schlereth SL. New Therapeutic Approaches for Conjunctival Melanoma-What We Know So Far and Where Therapy Is Potentially Heading: Focus on Lymphatic Vessels and Dendritic Cells. Int J Mol Sci 2022; 23:1478. [PMID: 35163401 PMCID: PMC8835854 DOI: 10.3390/ijms23031478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
Conjunctival melanoma (CM) accounts for 5% of all ocular melanomas and arises from malignantly transformed melanocytes in the conjunctival epithelium. Current therapies using surgical excision in combination with chemo- or cryotherapy still have high rates for recurrences and metastatic disease. Lately, novel signal transduction-targeted and immune checkpoint inhibitors like cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors, programmed cell death protein-1 (PD-1) receptor inhibitors, BRAF- or MEK-inhibitors for systemic treatment of melanoma have improved the outcome even for unresectable cutaneous melanoma, improving patient survival dramatically. The use of these therapies is now also recommended for CM; however, the immunological background of CM is barely known, underlining the need for research to better understand the immunological basics when treating CM patients with immunomodulatory therapies. Immune checkpoint inhibitors activate tumor defense by interrupting inhibitory interactions between tumor cells and T lymphocytes at the so-called checkpoints. The tumor cells exploit these inhibitory targets on T-cells that are usually used by dendritic cells (DCs). DCs are antigen-presenting cells at the forefront of immune response induction. They contribute to immune tolerance and immune defense but in the case of tumor development, immune tolerance is often prevalent. Enhancing the immune response via DCs, interfering with the lymphatic pathways during immune cell migration and tumor development and specifically targeting tumor cells is a major therapeutic opportunity for many tumor entities including CM. This review summarizes the current knowledge on the function of lymphatic vessels in tumor growth and immune cell transport and continues to compare DC subsets in CM with related melanomas, such as cutaneous melanoma and mucosal melanoma.
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Affiliation(s)
- Jennifer Peil
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.P.); (F.B.); (L.M.H.); (C.C.)
| | - Felix Bock
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.P.); (F.B.); (L.M.H.); (C.C.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50937 Cologne, Germany
| | - Friedemann Kiefer
- European Institute for Molecular Imaging (EIMI), University of Münster, 48149 Münster, Germany;
| | - Rebecca Schmidt
- Department of Oral, Maxillofacial and Plastic Facial Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany;
| | - Ludwig M. Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.P.); (F.B.); (L.M.H.); (C.C.)
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.P.); (F.B.); (L.M.H.); (C.C.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50937 Cologne, Germany
| | - Simona L. Schlereth
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.P.); (F.B.); (L.M.H.); (C.C.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50937 Cologne, Germany
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Bunod R, Tahiri Joutei Hassani R, Robin M, Liang H, Rabut G, Baudouin C, Labbé A. Evaluation of pterygium severity with en face anterior segment optical coherence tomography and correlations with in vivo confocal microscopy. J Fr Ophtalmol 2021; 44:1362-1369. [PMID: 34384622 DOI: 10.1016/j.jfo.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe en face anterior segment optical coherence tomography (EF-OCT) characteristics of pterygia and their correlation with in vivo confocal microscopy (IVCM). PATIENTS AND METHODS In this observational case series, we prospectively included 21 eyes of 17 subjects with pterygium. All subjects underwent detailed ophthalmic examination, anterior segment photography, an ocular surface disease index (OSDI) questionnaire, IVCM, and EF-OCT. Eyes were divided into two groups according to pterygium severity (Modified Pterygium Classification System) and OSDI score. EF-OCT images for both groups were analyzed for surface area of Fuchs Patches (FP). The IVCM activity score was based on the number of inflammatory cells, blood vessels, activated keratocytes and the appearance of the cornea/pterygium at the head of the pterygium. The correlations between EF-OCT and IVCM images were then analyzed and compared in both groups. RESULTS EF-OCT permits clear visualization and evaluation of FPs and the border between the pterygium and the adjacent cornea. The severe pterygium group was characterized by irregular borders and larger FPs (0.13±0.06 mm2 versus 0.06±0.02 mm2 respectively) (P=0.003). The mean IVCM activity score was 2.36±0.81 in the severe pterygium group and 1.2±0.42 in the mild pterygium group (P=0.0013). There was a positive correlation between FP surface area and IVCM activity score. A larger FP surface area was associated with a higher activity score on IVCM. CONCLUSION EF-OCT allows good evaluation of pterygium extension, borders and FP surface area. EF-OCT analysis of pterygium could represent a simple, non-invasive and reproducible method to evaluate pterygium severity and activity.
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Affiliation(s)
- R Bunod
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France.
| | | | - M Robin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France
| | - H Liang
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France
| | - G Rabut
- CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France
| | - C Baudouin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, University of Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - A Labbé
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, University of Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
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Yildiz-Tas A, Arici C, Mergen B, Sahin A. In Vivo Confocal Microscopy in Blepharitis Patients with Ocular Demodex Infestation. Ocul Immunol Inflamm 2021; 30:1378-1383. [PMID: 33793371 DOI: 10.1080/09273948.2021.1875006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare corneal in-vivo confocal microscopy (IVCM) findings in patients with seborrheic blepharitis with healthy controls and to evaluate the correlation with the Demodex load. METHODS Sixty-two Demodex positive seborrheic blepharitis patients and 24 controls were included. Four eyelashes from each eye were examined. The median value of Demodex count (5 mites/eye) was assigned as the cutoff value to create low and high Demodex infestation subgroups. Corneal nerve parameters (fiber length;CNFL, fiber density;CNFD, branch length;CNBL, branch density;CNBD) and dendritic cell density (DCD) were analyzed by IVCM for all participants. RESULTS The mean DCD of eyes in low (37.62 ± 25.18 cells/mm2) and high (76.00 ± 44.00 cells/mm2) Demodex load groups were significantly higher than those in the control group (14.25 ± 2.68 cells/mm2) (p < .001). CNFL, CNFD, CNBL and CNBD were significantly lower in low and high Demodex groups compared to controls (p < .001). CONCLUSIONS Demodex positive seborrheic blepharitis patients showed significantly reduced density of corneal nerves and elevated DCD levels.
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Affiliation(s)
- Ayse Yildiz-Tas
- Department of Ophthalmology, Koç University School of Medicine, Istanbul, Turkey
| | - Ceyhun Arici
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burak Mergen
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam Ve Sakura City Hospital, Istanbul, Turkey
| | - Afsun Sahin
- Department of Ophthalmology, Koç University School of Medicine, Istanbul, Turkey
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Abstract
A biomarker is a "characteristic that is measured as an indicator of normal biological processes, pathogenic processes, or responses to an exposure or intervention, including therapeutic interventions." Recently, calls for biomarkers for ocular surface diseases have increased, and advancements in imaging technologies have aided in allowing imaging biomarkers to serve as a potential solution for this need. This review focuses on the state of imaging biomarkers for ocular surface diseases, specifically non-invasive tear break-up time (NIBUT), tear meniscus measurement and corneal epithelial thickness with anterior segment optical coherence tomography (OCT), meibomian gland morphology with infrared meibography and in vivo confocal microscopy (IVCM), ocular redness with grading scales, and cellular corneal immune cells and nerve assessment by IVCM. Extensive literature review was performed for analytical and clinical validation that currently exists for potential imaging biomarkers. Our summary suggests that the reported analytical and clinical validation state for potential imaging biomarkers is broad, with some having good to excellent intra- and intergrader agreement to date. Examples of these include NIBUT for dry eye disease, ocular redness grading scales, and detection of corneal immune cells by IVCM for grading and monitoring inflammation. Further examples are nerve assessment by IVCM for monitoring severity of diabetes mellitus and neurotrophic keratitis, and corneal epithelial thickness assessment with anterior segment OCT for the diagnosis of early keratoconus. However, additional analytical validation for these biomarkers is required before clinical application as a biomarker.
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In Vivo Confocal Microscopy Observation of Cell and Nerve Density in Different Corneal Regions with Monocular Pterygium. J Ophthalmol 2020; 2020:6506134. [PMID: 32280527 PMCID: PMC7125477 DOI: 10.1155/2020/6506134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the effects of pterygium on corneal cell and nerve density in patients with unilateral pterygium using in vivo laser scanning confocal microscopy (LSCM). Methods In this cross-sectional study, 24 patients with unilateral pterygium who were treated in the Department of Ophthalmology of the Second People's Hospital of Wuxi City from April 2018 to July 2018 were analyzed. Each eye with pterygium and its fellow eye were imaged by LSCM. The density of basal corneal epithelial cells, anterior stromal cells, posterior stromal cells, dendritic cells, and endothelial cells in pterygium and adjacent clear cornea was measured. In the fellow eyes, the central cornea, nasal cornea, nasal mid-peripheral cornea, and temporal cornea were imaged. The difference in the density of cells and subepithelial nerve fibers in different corneal regions of eyes with pterygium was analyzed. The cell and nerve density of the fellow cornea were also measured to exclude the influencing factors. Results The density of corneal basal epithelial cells in the central corneas of eyes with pterygium was 6497 ± 1776 cells/mm2, which was higher than that in the area near the head of pterygium (5580 ± 1294 cells/mm2, P < 0.001), the region above pterygium (6097 ± 1281 cells/mm2, P=0.049), and the region below pterygium (5463 ± 1007 cells/mm2, P=0.001). The density of anterior stromal cells in the central cornea was 742 ± 243 cells/mm2, which was higher than that in the area near the head of pterygium (587 ± 189 cells/mm2, P=0.005), the region below pterygium (492 ± 159 cells/mm2, P=0.005), and the temporal cornea (574 ± 164 cells/mm2, P=0.003). The density of endothelial cells in the central cornea was 2398 ± 260 cells/mm2, which was higher than that in the area near the head of pterygium (2296 ± 231 cells/mm2, P=0.011) and the region below pterygium (2272 ± 400 cells/mm2, P=0.020). The density of dendritic cells in the central cornea was 53 ± 48 cells/mm2, which was lower than that in the area near the head of pterygium (250 ± 224 cells/mm2, P=0.001), the upper region (103 ± 47 cells/mm2, P=0.006), and the lower region (90 ± 48 cells/mm2, P=0.023). The corneal nerve fiber length (CNFL) in the center was higher than that in the area near the head of pterygium, the upper region, and the lower region. Compared with fellow eyes, eyes with pterygium had a significantly higher mean corneal power (KM) (P < 0.001). There was a significant positive linear relationship between the corneal area invaded by pterygium of pterygia and KM (r = 0.609, P=0.009). Conclusion Basal epithelial cells, stromal cells, endothelial cells, dendritic cells, and subepithelial nerve fibers in the central cornea of eyes with pterygium were different from those of pterygium and adjacent clear cornea. LSCM is effective for observing the morphology and quantity of corneal cells in pterygium.
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Kalogeropoulos D, Papoudou-Bai A, Lane M, Goussia A, Charchanti A, Moschos MM, Kanavaros P, Kalogeropoulos C. Antigen-presenting cells in ocular surface diseases. Int Ophthalmol 2020; 40:1603-1618. [PMID: 32107692 DOI: 10.1007/s10792-020-01329-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To review the role of antigen-presenting cells (APC) in the pathogenesis of ocular surface diseases (OSD). METHODS A thorough literature search was performed in PubMed database. An additional search was made in Google Scholar to complete the collected items. RESULTS APCs have the ability to initiate and direct immune responses and are found in most lymphoid and non-lymphoid tissues. APCs continuously sample their environment, present antigens to T cells and co-ordinate immune tolerance and responses. Many different types of APCs have been described and there is growing evidence that these cells are involved in the pathogenesis of OSD. OSD is a complex term for a myriad of disorders that are often characterized by ocular surface inflammation, tear film instability and impairment of vision. CONCLUSIONS This review summarizes the current knowledge concerning the immunotopographical distribution of APCs in the normal ocular surface. APCs appear to play a critical role in the pathology of a number of conditions associated with OSD including infectious keratitis, ocular allergy, dry eye disease and pterygium.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Mark Lane
- Birmingham and Midland Eye Centre, Birmingham, UK
| | - Anna Goussia
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Antonia Charchanti
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Corneal Reinnervation and Sensitivity Recovery after Pterygium Excision. J Ophthalmol 2020; 2020:1349072. [PMID: 32148934 PMCID: PMC7057010 DOI: 10.1155/2020/1349072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/02/2020] [Accepted: 01/27/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate changes in corneal sensitivity and subbasal nerve density after pterygium excision. Methods This prospective trial included 22 eyes with nasal primary pterygium and 18 controls. Corneal sensitivity was evaluated using a Cochet–Bonnet esthesiometer in the nasal, superior, temporal, inferior, and center quadrants of the cornea before surgery and 10 days, 1 month, and 3months after surgery. The central cornea was analyzed using in vivo confocal microscopy (IVCM) before surgery and 1 and 3 months after surgery. Subbasal nerve density and other nerve parameters were analyzed using NeuronJ. Nerve tortuosity was evaluated and graded in individual IVCM scans. The tear film break-up time (TBUT) test and Schirmer's test were performed before surgery, as well as 1 and 3 months after surgery. All the same tests were performed in the controls. Results All affected eyes showed a significant increase in corneal sensitivity in the nasal corneal quadrant after surgery when compared with preoperative data (F = 37.3; P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (F = 37.3; P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density (F = 37.3; P < 0.01). Compared with controls, pterygium patients demonstrated decreased corneal subbasal nerve density ( Conclusion Pterygium patients demonstrated deteriorated corneal subbasal nerve fibers when compared with healthy controls in terms of nerve length, nerve trunks, and nerve branches. Therefore, pterygium excision improves corneal sensitivity and increases corneal subbasal nerve density.
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Corneal epithelial dendritic cell density in the healthy human cornea: A meta-analysis of in-vivo confocal microscopy data. Ocul Surf 2019; 17:753-762. [PMID: 31279064 DOI: 10.1016/j.jtos.2019.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Numerous studies have reported a wide range of corneal epithelial dendritic cells (CEDC) density using in-vivo confocal microscopy in healthy participants. It is necessary to establish normal CEDC values for healthy corneas to enable differentiation from pathological corneas. This meta-analysis aimed to establish CEDC density and distribution and examine their relationship with age and sex. METHODS A systematic review of the literature of studies using the Heidelberg Retinal Tomograph with Rostock Corneal Module and reporting CEDC density in healthy subjects up to December 2018 was conducted via Medline, Google Scholar, Scopus, PubMed, Embase and Cochrane library. A random effect modeling approach was used to obtain the results of meta-analysis and meta-regression was conducted to estimate the effect of age and sex. RESULTS 38 studies reported central and 9 reported peripheral inferior CEDC density of 1203 participants (mean age 46.0 ± 12.2, range 18-81 years). CEDC density in the central and peripheral inferior cornea was 26.4 ± 13.6 cells/mm2 (95% CI:22.5-26.8) and 74.9 ± 22.7 cells/mm2 (95%CI:59.8-90.0), respectively. No effect of age was found on central CEDC density (p = 0.63); whereas peripheral CEDC density decreased with increasing age (p = 0.02). CEDC density was not influenced by sex at either location (p > 0.48). CONCLUSION This study established that the density at the peripheral inferior cornea is three-fold higher than at the central cornea. Peripheral but not central CEDC density decreased with increasing age. There are limited studies in youth (<18 years), precluding a more detailed analysis. Sex does not appear to be a significant factor in CEDC density.
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The Role of Limbal Epithelial Stem Cells in Regulating Corneal (Lymph)angiogenic Privilege and the Micromilieu of the Limbal Niche following UV Exposure. Stem Cells Int 2018; 2018:8620172. [PMID: 29853920 PMCID: PMC5964490 DOI: 10.1155/2018/8620172] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 04/18/2018] [Indexed: 12/02/2022] Open
Abstract
The cornea is a clear structure, void of blood, and lymphatic vessels, functioning as our window to the world. Limbal epithelial stem cells, occupying the area between avascular cornea and vascularized conjunctiva, have been implicated in tissue border maintenance, preventing conjunctivalisation and propagation of blood and lymphatic vessels into the cornea. Defects in limbal epithelial stem cells are linked to corneal neovascularisation, including lymphangiogenesis, chronic inflammation, conjunctivalisation, epithelial abnormalities including the presence of goblet cells, breaks in Bowman's membrane, persistent epithelial defects and ulceration, ocular surface squamous neoplasia, lipid keratopathy, pain, discomfort, and compromised vision. It has been postulated that pterygium is an example of focal limbal deficiency. Previous reports showing changes occurring in limbal epithelium during pterygium pathogenesis suggest that there is a link to stem cell damage. In this light, pterygium can serve as a model disease of UV-induced stem cell damage also characterised by corneal blood and lymphangiogenesis. This review focuses on the role of corneal and limbal epithelial cells and the stem cell niche in maintaining corneal avascularity and corneal immune privilege and how this may be deregulated following UV exposure. We present an overview of the PUBMED literature in the field as well as recent work from our laboratories.
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Reversal of Sensation of Conjunctival Autograft after Pterygium Surgery. Eur J Ophthalmol 2018; 22 Suppl 7:S11-6. [DOI: 10.5301/ejo.5000082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2011] [Indexed: 11/20/2022]
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Correlation between corneal innervation and inflammation evaluated with confocal microscopy and symptomatology in patients with dry eye syndromes: a preliminary study. Graefes Arch Clin Exp Ophthalmol 2017; 255:1771-1778. [DOI: 10.1007/s00417-017-3680-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/02/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022] Open
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Bilateral Alterations in Corneal Nerves, Dendritic Cells, and Tear Cytokine Levels in Ocular Surface Disease. Cornea 2017; 35 Suppl 1:S65-S70. [PMID: 27617877 DOI: 10.1097/ico.0000000000000989] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review summarizes the recent literature regarding corneal imaging in human subjects using in vivo confocal microscopy. It also covers the recent literature on corneal immune cells, nerves, and tear cytokine levels in ocular surface diseases as well as corneal immune privilege. The significance of interactions between corneal immune cells and nerves in health, neurotrophic keratopathy, and infectious keratitis is discussed. Furthermore, bilateral alterations of immune cells and nerves in clinically unilateral corneal diseases and the link to changes of tear cytokines or neuropeptide levels in contralateral eyes are described. Recent studies reported increased density and morphologic changes of corneal dendritic cells in ocular surface disease that correlated with a decrease in subbasal nerve and corneal nerve density, suggesting potential interactions between the immune and nervous systems in the cornea. Although the relevance of tear cytokines is poorly understood, tear cytokines might have an important role in the pathogenesis of ocular surface diseases. In humans and experimental animal models, alterations in immune cells, cytokines, and immunomodulatory neuropeptide levels in contralateral eyes might mediate the incidence of bilateral infectious keratitis and loss of immune privilege of the cornea in bilateral corneal transplantation or neurotrophic keratopathy cases. The discovery of bilateral alterations of immune cells and nerves in ocular surface diseases is considered the missing link between the immune and nervous systems in the cornea, and demonstrates how studies of animal models and humans aid our understanding of human corneal disease phenomena.
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The impact of lens care solutions on corneal epithelial changes during daily silicone hydrogel contact lens wear as measured by in vivo confocal microscopy. Cont Lens Anterior Eye 2017; 40:33-41. [DOI: 10.1016/j.clae.2016.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022]
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Cruzat A, Qazi Y, Hamrah P. In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease. Ocul Surf 2017; 15:15-47. [PMID: 27771327 PMCID: PMC5512932 DOI: 10.1016/j.jtos.2016.09.004] [Citation(s) in RCA: 218] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 09/19/2016] [Accepted: 09/25/2016] [Indexed: 12/20/2022]
Abstract
In vivo confocal microscopy (IVCM) is becoming an indispensable tool for studying corneal physiology and disease. Enabling the dissection of corneal architecture at a cellular level, this technique offers fast and noninvasive in vivo imaging of the cornea with images comparable to those of ex vivo histochemical techniques. Corneal nerves bear substantial relevance to clinicians and scientists alike, given their pivotal roles in regulation of corneal sensation, maintenance of epithelial integrity, as well as proliferation and promotion of wound healing. Thus, IVCM offers a unique method to study corneal nerve alterations in a myriad of conditions, such as ocular and systemic diseases and following corneal surgery, without altering the tissue microenvironment. Of particular interest has been the correlation of corneal subbasal nerves to their function, which has been studied in normal eyes, contact lens wearers, and patients with keratoconus, infectious keratitis, corneal dystrophies, and neurotrophic keratopathy. Longitudinal studies have applied IVCM to investigate the effects of corneal surgery on nerves, demonstrating their regenerative capacity. IVCM is increasingly important in the diagnosis and management of systemic conditions such as peripheral diabetic neuropathy and, more recently, in ocular diseases. In this review, we outline the principles and applications of IVCM in the study of corneal nerves in various ocular and systemic diseases.
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Affiliation(s)
- Andrea Cruzat
- Cornea & Refractive Surgery Service, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yureeda Qazi
- Cornea & Refractive Surgery Service, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Pedram Hamrah
- Cornea & Refractive Surgery Service, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA; Boston Image Reading Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA.
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Cruzat A, Schrems WA, Schrems-Hoesl LM, Cavalcanti BM, Baniasadi N, Witkin D, Pavan-Langston D, Dana R, Hamrah P. Contralateral Clinically Unaffected Eyes of Patients With Unilateral Infectious Keratitis Demonstrate a Sympathetic Immune Response. Invest Ophthalmol Vis Sci 2016; 56:6612-20. [PMID: 26465889 DOI: 10.1167/iovs.15-16560] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To analyze the contralateral unaffected eyes of patients with microbial keratitis (MK) for any immune cell or nerve changes by laser in vivo confocal microscopy (IVCM). METHODS A prospective study was performed on 28 patients with MK, including acute bacterial, fungal, and Acanthamoeba keratitis, as well as on their contralateral clinically unaffected eyes and on control groups, which consisted of 28 age-matched normal controls and 15 control contact lens (CL) wearers. Laser IVCM with the Heidelberg Retinal Tomograph 3/Rostock Cornea Module and Cochet-Bonnet esthesiometry of the central cornea were performed. Two masked observers assessed central corneal dendritiform cell density and subbasal corneal nerve parameters. RESULTS The contralateral clinically unaffected eyes of patients with MK demonstrated significant diminishment in nerve density (15,603.8 ± 1265.2 vs. 24,102.1 ± 735.6 μm/mm²), total number of nerves (11.9 ± 1.0 vs. 24.9 ± 1.2/frame), number of branches (1.7 ± 0.2 vs. 19.9 ± 1.3/frame), and branch nerve length (5775.2 ± 757.1 vs. 12,715.4 ± 648.4 μm/mm²) (P < 0.001 for all parameters) compared to normal controls and CL wearers. Further, dendritiform cell density in the contralateral unaffected eyes was significantly increased as compared to that in controls (117.5 ± 19.9 vs. 24.2 ± 3.5 cells/mm², P < 0.001). CONCLUSIONS We demonstrate a subclinical involvement in the contralateral clinically unaffected eyes in patients with unilateral acute MK. In vivo confocal microscopy reveals not only a diminishment of the subbasal corneal nerves and sensation, but also an increase in dendritiform cell density in the contralateral unaffected eyes of MK patients. These findings show bilateral immune alterations in a clinically unilateral disease.
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Affiliation(s)
- Andrea Cruzat
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States 2Department of Ophthalmology, Pontificia Universidad Católi
| | - Wolfgang A Schrems
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Laura M Schrems-Hoesl
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Bernardo M Cavalcanti
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Neda Baniasadi
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Deborah Witkin
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Deborah Pavan-Langston
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Reza Dana
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Pedram Hamrah
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States 3Boston Image Reading Center and Cornea Service, New Englan
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Diagnosing ocular surface squamous neoplasia in East Africa: case-control study of clinical and in vivo confocal microscopy assessment. Ophthalmology 2013; 121:484-91. [PMID: 24321141 PMCID: PMC3901930 DOI: 10.1016/j.ophtha.2013.09.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/06/2013] [Accepted: 09/18/2013] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To examine the reliability of clinical examination and in vivo confocal microscopy (IVCM) in distinguishing ocular surface squamous neoplasia (OSSN) from benign conjunctival lesions. DESIGN Case-control study. PARTICIPANTS Sixty individuals with conjunctival lesions (OSSN and benign) and 60 age-matched controls with normal conjunctiva presenting to Kilimanjaro Christian Medical Centre, Moshi, Tanzania. METHODS Participants were examined and photographed, and IVCM was performed. Patients with conjunctival lesions were offered excisional biopsy with histopathology and a human immunodeficiency virus (HIV) test. The IVCM images were read masked to the clinical appearance and pathology results. Images were graded for several specific features and given an overall categorization (normal, benign, or malignant). A group of 8 ophthalmologists were shown photographs of conjunctival lesions and asked to independently classify as OSSN or benign. MAIN OUTCOME MEASURES Comparison of the histopathology diagnosis with the clinical and IVCM diagnosis. RESULTS Fifty-two cases underwent excisional biopsy with histopathology; 34 were on the OSSN spectrum, 17 were benign, and 1 was lymphoma. The cases and controls had comparable demographic profiles. Human immunodeficiency syndrome infection was more common in OSSN compared with benign cases (58.8% vs. 5.6%; odds ratio, 24.3, 95% confidence interval [CI], 2.8-204; P = 0.003). Clinically, OSSN lesions more frequently exhibited feeder vessels and tended to have more leukoplakia and a gelatinous appearance. Overall, the ophthalmologists showed moderate agreement with the histology result (average kappa = 0.51; 95% CI, 0.36-0.64). The masked grading of IVCM images reliably distinguished normal conjunctiva. However, IVCM was unable to reliably distinguish between benign lesions and OSSN because of an overlap in their appearance (kappa = 0.44; 95% CI, 0.32-0.57). No single feature was significantly more frequent in OSSN compared with benign lesions. The sensitivity and specificity of IVCM for distinguishing OSSN from benign conjunctival lesions were 38.5% and 66.7%, respectively. CONCLUSIONS In East Africa, conjunctival pathology is relatively common and can present significant diagnostic challenges for the clinician. In this study, neither clinical examination nor IVCM was found to reliably distinguish OSSN from benign conjunctival pathology because of an overlap in the features of these groups. Therefore, IVCM cannot currently replace histopathology, and management decisions should continue to rely on careful clinical assessment supported by histopathology as indicated.
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Kymionis GD, Diakonis VF, Shehadeh MM, Pallikaris AI, Pallikaris IG. Anterior Segment Applications of In Vivo Confocal Microscopy. Semin Ophthalmol 2013; 30:243-51. [DOI: 10.3109/08820538.2013.839817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Patel DV, McGhee CN. Quantitative analysis of in vivo confocal microscopy images: A review. Surv Ophthalmol 2013; 58:466-75. [DOI: 10.1016/j.survophthal.2012.12.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 12/09/2012] [Accepted: 12/11/2012] [Indexed: 12/17/2022]
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Hu VH, Holland MJ, Cree IA, Pullin J, Weiss HA, Massae P, Makupa W, Mabey DCW, Bailey RL, Burton MJ, Luthert P. In vivo confocal microscopy and histopathology of the conjunctiva in trachomatous scarring and normal tissue: a systematic comparison. Br J Ophthalmol 2013; 97:1333-7. [PMID: 23922266 PMCID: PMC3786664 DOI: 10.1136/bjophthalmol-2013-303126] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM To compare in vivo confocal microscopy (IVCM) with the histopathological examination of tissue and cellular changes in normal and diseased conjunctiva. METHODS Participants underwent clinical examination and IVCM of the tarsal conjunctiva. A biopsy of the upper tarsal conjunctiva was collected and stained with tinctorial stains and by immunohistochemical staining for CD45 and CD83. Connective tissue scarring, inflammatory cell density and the presence of dendritiform cells were quantitatively assessed in a masked manner by both IVCM and histological assessments for comparative analysis. RESULTS Thirty-four participants with severe trachomatous conjunctival scarring and 33 participants with healthy conjunctiva were recruited. The IVCM connective tissue scarring score was strongly associated with the histological grading of scarring (p<0.001). There was limited evidence of an association between the IVCM inflammatory cell infiltrate and the histological inflammatory cell grade (p=0.05). We did not find any evidence to support the hypothesis that dendritiform cells seen with IVCM are mature, conventional dendritic cells. CONCLUSIONS The results show that IVCM can be used to robustly quantitate connective tissue scarring and also has a role in measuring the inflammatory cell infiltrate. The discordance between IVCM dendritiform cells and immunohistochemical dendritic cells may be a result of study limitations or may be because these dendritiform structures represent another cell type, such as fibroblasts, rather than dendritic cells.
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Affiliation(s)
- Victor H Hu
- Faculty of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, , London, UK
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Application of In Vivo Laser Scanning Confocal Microscopy for Evaluation of Ocular Surface Diseases: Lessons Learned From Pterygium, Meibomian Gland Disease, and Chemical Burns. Cornea 2011; 30 Suppl 1:S25-8. [DOI: 10.1097/ico.0b013e318227fcd9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cruzat A, Witkin D, Baniasadi N, Zheng L, Ciolino JB, Jurkunas UV, Chodosh J, Pavan-Langston D, Dana R, Hamrah P. Inflammation and the nervous system: the connection in the cornea in patients with infectious keratitis. Invest Ophthalmol Vis Sci 2011; 52:5136-43. [PMID: 21460259 DOI: 10.1167/iovs.10-7048] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To study the density and morphologic characteristics of epithelial dendritic cells, as correlated to subbasal corneal nerve alterations in acute infectious keratitis (IK) by in vivo confocal microscopy (IVCM). METHODS IVCM of the central cornea was performed prospectively in 53 eyes with acute bacterial (n = 23), fungal (n = 13), and Acanthamoeba (n = 17) keratitis, and in 20 normal eyes, by using laser in vivo confocal microscopy. Density and morphology of dendritic-shaped cells (DCs) of the central cornea, corneal nerve density, nerve numbers, branching, and tortuosity were assessed and correlated. It should be noted that due to the "in vivo" nature of the study, the exact identity of these DCs cannot be specified, as they could be monocytes or tissue macrophages, but most likely dendritic cells. RESULTS IVCM revealed the presence of central corneal DCs in all patients and controls. The mean DC density was significantly higher in patients with bacterial (441.1 ± 320.5 cells/mm(2); P < 0.0001), fungal (608.9 ± 812.5 cells/mm(2); P < 0.0001), and Acanthamoeba keratitis (1000.2 ± 1090.3 cells/mm(2); P < 0.0001) compared with controls (49.3 ± 39.6 cells/mm(2)). DCs had an increased size and dendrites in patients with IK. Corneal nerves were significantly reduced in eyes with IK compared with controls across all subgroups, including nerve density (674.2 ± 976.1 vs. 3913.9 ± 507.4 μm/frame), total nerve numbers (2.7 ± 3.9 vs. 20.2 ± 3.3), main trunks (1.5 ± 2.2 vs. 6.9 ± 1.1), and branching (1.2 ± 2.0 vs. 13.5 ± 3.1; P < 0.0001). A strong association between the diminishment of corneal nerves and the increase of DC density was observed (r = -0.44; P < 0.0005). CONCLUSIONS IVCM reveals an increased density and morphologic changes of central epithelial DCs in infectious keratitis. There is a strong and significant correlation between the increase in DC numbers and the decreased subbasal corneal nerves, suggesting a potential interaction between the immune and nervous system in the cornea.
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Affiliation(s)
- Andrea Cruzat
- Ocular Surface Imaging Center, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, USA
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