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Schmitz F, Klimas R, Spenner M, Schumacher A, Hieke A, Greiner T, Enax-Krumova E, Sgodzai M, Fels M, Brünger J, Huckemann S, Stude P, Tegenthoff M, Gold R, Philipps J, Fisse AL, Grüter T, Pitarokoili K, Motte J, Sturm D. Morphological Differentiation of Corneal Inflammatory Cells: Proposal of Pragmatic Protocol. Cornea 2024:00003226-990000000-00534. [PMID: 38588437 DOI: 10.1097/ico.0000000000003543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/18/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Corneal confocal microscopy is a noninvasive imaging technique to analyze corneal nerve fibers and corneal inflammatory cells (CICs). The amount of CICs is a potential biomarker of disease activity in chronic autoinflammatory diseases. To date, there are no standardized criteria for the morphological characterization of CICs. The aim was to establish a protocol for a standardized morphological classification of CICs based on a literature search and to test this protocol for applicability and reliability. METHODS A systematic review of the literature about definitions of CICs was conducted. Existing morphological descriptions were translated into a structured algorithm and applied by raters. Subsequently, the protocol was optimized by reducing and defining the criteria of the cell types. The optimized algorithm was applied by 4 raters. The interrater reliability was calculated using Fleiss kappa (K). RESULTS A systematic review of the literature revealed no uniform morphological criteria for the differentiation of the individual cell types in CICs. Our first protocol achieved only a low level of agreement between 3 raters (K = 0.09; 1062 rated cells). Our revised protocol was able to achieve a higher interrater reliability with 3 (K = 0.64; 471 rated cells) and 4 (K = 0.61; 628 rated cells) raters. CONCLUSIONS The indirect use of criteria from the literature leads to a high error rate. By clearly defining the individual cell types and standardizing the protocol, reproducible results were obtained, allowing the introduction of this protocol for the future evaluation of CICs in the corneal confocal microscopy.
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Affiliation(s)
- Fynn Schmitz
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Marie Spenner
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Aurelian Schumacher
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Alina Hieke
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Tineke Greiner
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Elena Enax-Krumova
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Miriam Fels
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Sophie Huckemann
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Philipp Stude
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Martin Tegenthoff
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jörg Philipps
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Dietrich Sturm
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
- Department of Neurology, Agaplesion Bethesda Krankenhaus, Wuppertal, Germany; and
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Chen M, Seo S, Simmons X, Maroud Y, Wong T, Schubert W, Yiu SC. Precise longitudinal monitoring of corneal change through in vivo confocal microscopy in a rat dry eye disease model. Mol Vis 2024; 30:150-159. [PMID: 39076769 PMCID: PMC11286106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose While lacrimal gland removal is commonly used in animal models to replicate dry eye disease, research into systematically monitoring dry eye disease's longitudinal pathological changes is limited. In vivo confocal microscopy (Heidelberg Retina Tomograph 3 with a Rostock Cornea Module, Heidelberg Engineering Inc., Franklin, MA) can non-invasively reveal corneal histopathological structures. To monitor dry-eye-disease-related changes in corneal structures, we developed a precise monitoring method using in vivo confocal microscopy in a rat double lacrimal gland removal model. Methods Five Sprague-Dawley rats (age 8-9 weeks, male) underwent double lacrimal gland removal. Modified Schirmer's tear test, blink tests, and in vivo confocal microscopy images were acquired pre-surgery and at 1, 2, and 4 weeks post-surgery. Three individual stromal nerves were selected per eye as guide images, and images of the corresponding sub-basal nerve plexus area were acquired via volume acquisition. The same area was re-imaged in subsequent weeks. Results After double lacrimal gland removal, tear production was reduced by 60%, and the blink rate increased 10 times compared to pre-surgery. Starting from 1 week after surgery, in vivo confocal microscopy showed increased sub-basal nerve plexus nerve fiber density with inflammatory cell infiltration at the sub-basal nerve plexus layer and remained at an elevated level at 2 and 4 weeks post-surgery. Conclusions We demonstrated that our precise monitoring method revealed detailed changes in the corneal nerves, the epithelium, and the stroma.
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Affiliation(s)
- Minjie Chen
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stefanie Seo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xianni Simmons
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Youssef Maroud
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trystin Wong
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Samuel C Yiu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Mobeen R, Stapleton F, Chao C, Huynh MC, Phoebe Wong YS, Naduvilath T, Golebiowski B. Epithelial Immune Cell Response to Initial Soft Contact Lens Wear in the Human Corneal and Conjunctival Epithelium. Invest Ophthalmol Vis Sci 2023; 64:18. [PMID: 38099736 PMCID: PMC10729840 DOI: 10.1167/iovs.64.15.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose The purpose of this study was to assess the immediate ocular immune response to soft contact lens (CL) wear by examining presumed epithelial immune cell (EIC) density and morphology at the central, peripheral, limbal cornea, and conjunctiva. Methods Fifty-four participants naïve to CL wear (mean age = 24.8 ± 9.8 years, 44% female participants), were examined using in vivo confocal microscopy at baseline and after 2 hours of CL wear (1-Day ACUVUE MOIST). Images were captured at the central, temporal far peripheral and limbal cornea, and bulbar conjunctiva. EIC density was counted manually and morphology was graded. Differences in EIC parameters pre- and post-CL wear were examined using a generalized estimating equation model with appropriate post hoc analyses. Results After 2 hours of soft CL wear, there was a significant increase in EIC density in all regions other than the central cornea (all P < 0.001). Cell body size was significantly larger, and a higher proportion of participants exhibited EIC with long dendrites after lens wear at the central and peripheral cornea (both P < 0.001). There was a significant increase in the number of participants displaying EIC with thick dendrites at the peripheral (P = 0.04) and limbal cornea (P < 0.001) after lens wear. Conclusions EICs were primarily recruited to the peripheral regions, whereas the central cornea shows no significant recruitment after short-term CL wear. Both central and peripheral corneas exhibited an enhanced antigen capture capacity, whereas migratory capacity was increased in the peripheral corneal regions suggesting EIC activation following a short period of CL wear.
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Affiliation(s)
- Rabia Mobeen
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Sydney, Australia
| | - Cecilia Chao
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Sydney, Australia
| | - Mandy C. Huynh
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Sydney, Australia
| | - Yee S. Phoebe Wong
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Sydney, Australia
| | - Thomas Naduvilath
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Sydney, Australia
- Brien Holden Vision Institute, University of New South Wales, New South Wales, Sydney, Australia
| | - Blanka Golebiowski
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Sydney, Australia
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Downie LE, Zhang X, Wu M, Karunaratne S, Loi JK, Senthil K, Arshad S, Bertram K, Cunningham AL, Carnt N, Mueller SN, Chinnery HR. Redefining the human corneal immune compartment using dynamic intravital imaging. Proc Natl Acad Sci U S A 2023; 120:e2217795120. [PMID: 37487076 PMCID: PMC10400993 DOI: 10.1073/pnas.2217795120] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/13/2023] [Indexed: 07/26/2023] Open
Abstract
The healthy human cornea is a uniquely transparent sensory tissue where immune responses are tightly controlled to preserve vision. The cornea contains immune cells that are widely presumed to be intraepithelial dendritic cells (DCs). Corneal immune cells have diverse cellular morphologies and morphological alterations are used as a marker of inflammation and injury. Based on our imaging of corneal T cells in mice, we hypothesized that many human corneal immune cells commonly defined as DCs are intraepithelial lymphocytes (IELs). To investigate this, we developed functional in vivo confocal microscopy (Fun-IVCM) to investigate cell dynamics in the human corneal epithelium and stroma. We show that many immune cells resident in the healthy human cornea are T cells. These corneal IELs are characterized by rapid, persistent motility and interact with corneal DCs and sensory nerves. Imaging deeper into the corneal stroma, we show that crawling macrophages and rare motile T cells patrol the tissue. Furthermore, we identify altered immune cell behaviors in response to short-term contact lens wear (acute inflammatory stimulus), as well as in individuals with allergy (chronic inflammatory stimulus) that was modulated by therapeutic intervention. These findings redefine current understanding of immune cell subsets in the human cornea and reveal how resident corneal immune cells respond and adapt to chronic and acute stimuli.
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Affiliation(s)
- Laura E. Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, VIC3053, Australia
| | - Xinyuan Zhang
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, VIC3053, Australia
| | - Mengliang Wu
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, VIC3053, Australia
| | - Senuri Karunaratne
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, VIC3053, Australia
| | - Joon Keit Loi
- Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3010, Australia
| | - Kirthana Senthil
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, VIC3053, Australia
- Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3010, Australia
| | - Sana Arshad
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW2145, Australia
| | - Kirstie Bertram
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW2145, Australia
| | - Anthony L. Cunningham
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW2145, Australia
| | - Nicole Carnt
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW2145, Australia
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW2052, Australia
- Institute of Ophthalmology, University College London, LondonEC1V 9EL, United Kingdom
| | - Scott N. Mueller
- Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC3010, Australia
| | - Holly R. Chinnery
- Department of Optometry and Vision Sciences, The University of Melbourne, Carlton, VIC3053, Australia
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Tajbakhsh Z, Jalbert I, Stapleton F, Briggs N, Golebiowski B. Diurnal changes and topographical distribution of ocular surface epithelial dendritic cells in humans, and repeatability of density and morphology assessment. Ophthalmic Physiol Opt 2023; 43:273-283. [PMID: 36592129 PMCID: PMC10108257 DOI: 10.1111/opo.13087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Dendritic cells (DC) play a crucial role in ocular surface defence. DC can be visualised in vivo by confocal microscopy but have not yet been fully characterised in humans. This study investigated the diurnal variation, topographical distribution and repeatability of DC density and morphology measurements. METHODS In vivo confocal microscopy (IVCM) was conducted on 20 healthy participants (mean age 32.7 ± 6.4 years, 50% female) at baseline and repeated after 30 minutes, 2, 6 and 24 h. Images were captured at the corneal centre, inferior whorl, corneal periphery, limbus and bulbar conjunctiva. DC were counted manually, and their morphology was assessed for cell body size, presence of dendrites, and presence of long and thick dendrites. Mixed-model analysis, non-parametric analyses, Bland and Altman plots, coefficient of repeatability (CoR) and kappa were used. RESULTS There were no significant changes in DC density (p ≥ 0.74) or morphology (p > 0.07) at any location over the 24-h period. The highest DC density was observed at the corneal limbus followed by the peripheral cornea (p < 0.001), with the lowest density at the corneal centre, inferior whorl and bulbar conjunctiva. Most DC at the corneal periphery, limbus and bulbar conjunctiva had larger cell bodies compared with the corneal centre (p ≤ 0.01), and the presence of long dendrites was observed mostly at non-central locations. Day-to-day CoR for DC density ranged from ±28.1 cells/mm2 at the corneal centre to ±56.4 cells/mm2 at the limbus. Day-to-day agreement of DC morphology determined by kappa ranged from 0.5 to 0.95 for cell body size, 0.60 to 0.95 for presence of dendrites, and 0.55 to 0.80 for the presence of long dendrites at various locations. CONCLUSIONS No diurnal changes are apparent in corneal or conjunctival DC. Substantial topographical differences exist in DC density and morphology. IVCM provides good repeatability of DC density and acceptable agreement of DC morphology.
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Affiliation(s)
- Zahra Tajbakhsh
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Blanka Golebiowski
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Dericioğlu V, Akkaya Turhan S, Erdem HE, Sevik MO, Erdil E, Sünter G, Ağan K, Toker E. In Vivo Corneal Confocal Microscopy in Multiple Sclerosis: Can it Differentiate Disease Relapse in Multiple Sclerosis? Am J Ophthalmol 2023; 250:138-148. [PMID: 36669610 DOI: 10.1016/j.ajo.2023.01.015] [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: 07/12/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE This study aims to investigate the role of in vivo corneal confocal microscopy (IVCCM) in the detection of corneal inflammatory activity and subbasal nerve alterations in patients with multiple sclerosis (MS) and to further determine whether IVCCM can be used to detect (acute) disease relapse. DESIGN Prospective cross-sectional study, with a subgroup follow-up. METHODS This single-center study included 58 patients with MS (MS-Relapse group [n = 27] and MS-Remission group [n = 31]), and 30 age- and sex-matched healthy control subjects. Patients with a history of optic neuritis or trigeminal symptoms were excluded. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and dendritic cell (DC) density were evaluated in all patients with MS and control subjects by IVCCM. Patients in the MS-Relapse group who were in remission for ≥6 months after the MS incident underwent a repeat IVCCM. RESULTS No statistical difference was observed between the MS-Relapse and MS-Remission groups regarding age, sex, MS duration, and the number of relapses (P > .05). Compared with healthy control subjects, all subbasal nerve parameters were significantly lower (CNFD: P < .001, CNFL: P < .001, CNBD: P < .001), and the DC density was significantly higher (P = .023) in patients with MS. However, no significant difference was observed between MS-Relapse and MS-Remission groups in terms of CNFD (mean [SE] difference -2.05 [1.69] fibers/mm2 [95% confidence interval {CI} -1.32 to 5.43]; P < .227), CNFL (mean [SE] difference -1.10 [0.83] mm/mm2 [95% CI -0.56 to 2.75]; P < .190), CNBD (mean [SE] difference -3.91 [2.48] branches/mm2 [95% CI -1.05 to 8.87]; P < .120), and DC density (median [IQR], 59.38 [43.75-85.0] vs 75.0 [31.25-128.75]; P = .596). The repeat IVCCM in relapse patients (n = 16 [59.3%]) showed a significant increase in CNFD (P = .036) and CNBD (P = .018), but no change was observed in CNFL (P = .075) and DC density (P = .469). CONCLUSION Although increased inflammation and neurodegeneration can be demonstrated in patients with MS compared with healthy control subjects, a single time point evaluation of IVCCM does not seem to be sufficient to confirm the occurrence of relapse in patients with MS. However, IVCCM holds promise for demonstrating early neuroregeneration in patients with MS.
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Affiliation(s)
- Volkan Dericioğlu
- From the Department of Ophthalmology (V.D., S.A.T., H.E.E., M.O.S.), Marmara University School of Medicine, Istanbul, Turkey.
| | - Semra Akkaya Turhan
- From the Department of Ophthalmology (V.D., S.A.T., H.E.E., M.O.S.), Marmara University School of Medicine, Istanbul, Turkey
| | - Halit Eren Erdem
- From the Department of Ophthalmology (V.D., S.A.T., H.E.E., M.O.S.), Marmara University School of Medicine, Istanbul, Turkey
| | - Mehmet Orkun Sevik
- From the Department of Ophthalmology (V.D., S.A.T., H.E.E., M.O.S.), Marmara University School of Medicine, Istanbul, Turkey
| | - Esra Erdil
- and the Department of Neurology (E.E., G.S., K.A.), Marmara University School of Medicine, Istanbul, Turkey
| | - Gülin Sünter
- and the Department of Neurology (E.E., G.S., K.A.), Marmara University School of Medicine, Istanbul, Turkey
| | - Kadriye Ağan
- and the Department of Neurology (E.E., G.S., K.A.), Marmara University School of Medicine, Istanbul, Turkey
| | - Ebru Toker
- and the Department of Ophthalmology and Visual Sciences (E.T.), West Virginia University, Morgantown, West Virginia, USA
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Liu F, Liu C, Lee IXY, Lin MTY, Liu YC. Corneal dendritic cells in diabetes mellitus: A narrative review. Front Endocrinol (Lausanne) 2023; 14:1078660. [PMID: 36777336 PMCID: PMC9911453 DOI: 10.3389/fendo.2023.1078660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Diabetes mellitus is a global public health problem with both macrovascular and microvascular complications, such as diabetic corneal neuropathy (DCN). Using in-vivo confocal microscopy, corneal nerve changes in DCN patients can be examined. Additionally, changes in the morphology and quantity of corneal dendritic cells (DCs) in diabetic corneas have also been observed. DCs are bone marrow-derived antigen-presenting cells that serve both immunological and non-immunological roles in human corneas. However, the role and pathogenesis of corneal DC in diabetic corneas have not been well understood. In this article, we provide a comprehensive review of both animal and clinical studies that report changes in DCs, including the DC density, maturation stages, as well as relationships between the corneal DCs, corneal nerves, and corneal epithelium, in diabetic corneas. We have also discussed the associations between the changes in corneal DCs and various clinical or imaging parameters, including age, corneal nerve status, and blood metabolic parameters. Such information would provide valuable insight into the development of diagnostic, preventive, and therapeutic strategies for DM-associated ocular surface complications.
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Affiliation(s)
- Fengyi Liu
- University of Cambridge, Girton College, Cambridgeshire, United Kingdom
| | - Chang Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Isabelle Xin Yu Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Molly Tzu Yu Lin
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Yu-Chi Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, National Taiwan University, Taipei, Taiwan
- *Correspondence: Yu-Chi Liu,
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8
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Impact of Chronic Kidney Disease on Corneal Neuroimmune Features in Type 2 Diabetes. J Clin Med 2022; 12:jcm12010016. [PMID: 36614815 PMCID: PMC9820846 DOI: 10.3390/jcm12010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Aim: To determine the impact of chronic kidney disease on corneal nerve measures and dendritic cell counts in type 2 diabetes. Methods: In vivo corneal confocal microscopy images were used to estimate corneal nerve parameters and compared in people with type 2 diabetes with chronic kidney disease (T2DM-CKD) (n = 29) and those with type 2 diabetes without chronic kidney disease (T2DM-no CKD) (n = 29), along with 30 healthy controls. Corneal dendritic cell densities were compared between people with T2DM-CKD and those with T2DM-no CKD. The groups were matched for neuropathy status. Results: There was a significant difference in corneal nerve fiber density (p < 0.01) and corneal nerve fiber length (p = 0.04) between T2DM-CKD and T2DM-no CKD groups. The two diabetes groups had reduced corneal nerve parameters compared to healthy controls (all parameters: p < 0.01). Immature central dendritic cell density was significantly higher in the T2DM-CKD group compared to the T2DM-no CKD group ((7.0 (3.8−12.8) and 3.5 (1.4−13.4) cells/mm2, respectively, p < 0.05). Likewise, central mature dendritic cell density was significantly higher in the T2DM-CKD group compared to the T2DM-no CKD group (0.8 (0.4−2.2) and 0.4 (0.6−1.1) cells/mm2, respectively, p = 0.02). Additionally, total central dendritic cell density was increased in the T2DM-CKD group compared to T2DM-no CKD group (10.4 (4.3−16.1) and 3.9 (2.1−21.0) cells/mm2, respectively, p = 0.03). Conclusion: The study showed that central corneal dendritic cell density is increased in T2DM-CKD compared to T2DM-no CKD, with groups matched for peripheral neuropathy severity. This is accompanied by a loss of central corneal nerve fibers. The findings raise the possibility of additional local factors exacerbating central corneal nerve injury in people with diabetic chronic kidney disease.
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9
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Chao C, Tajbakhsh Z, Stapleton F, Mobeen R, Madigan MC, Jalbert I, Briggs N, Golebiowski B. Corneal epithelial dendritic cells, tear neuropeptides and corneal nerves continue to be affected more than 12 months after LASIK. Acta Ophthalmol 2022; 101:e302-e314. [PMID: 36250753 DOI: 10.1111/aos.15270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE LASIK causes corneal nerve damage and may affect the neuro-immune crosstalk. This study examined the effects of LASIK on corneal epithelial dendritic cells (CEDC) density and morphology and explored their relationships with corneal nerves and tear neuropeptides. A grading system was developed to assess CEDC morphology. METHODS Intra- and inter-observer repeatability of the CEDC morphology grading system was established using kappa (κ). In vivo confocal microscope images of the central cornea were captured from 20 participants who had undergone LASIK 12-16 months earlier and 20 controls (age 18-32 years, 55%F). CEDC density was counted manually, and CEDC morphology was assessed using a new grading system. CEDC sub-types (contacting nerves [CEDCc] and not contacting nerves [CEDCnc]) were also assessed. Differences in CEDC density and morphology were examined using mixed models and chi-squared test. Relationships between CEDC and corneal nerve parameters and tear substance P were explored using Spearman's correlation. RESULTS Excellent intra- and inter-observer repeatability was demonstrated for the grading system (κ = 0.82-0.97). In post-LASIK participants, CEDC density was lower compared with controls (5 [0-34] vs. 21 [7-77] cells/mm2 ; p = 0.01), and the proportion of CEDC with thick dendrites was higher (55%-73% vs. 11%-21%, p < 0.003). Higher tear substance P levels were associated with higher CEDC density (rho = 0.48, p = 0.003). Fewer nerve interconnections were observed in participants in whom CEDC had dendrites (p = 0.03). CEDC sub-types followed a similar pattern to CEDC. CONCLUSIONS The findings suggest that CEDC may remain altered more than 12 months post-LASIK. The association with substance P suggests a role for CEDC in corneal neurogenic inflammation.
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Affiliation(s)
- Cecilia Chao
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Zahra Tajbakhsh
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Rabia Mobeen
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Michele C Madigan
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia.,Save Sight Institute, University of Sydney, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, Australia
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10
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Alotaibi S, Ozkan J, Papas E, Markoulli M. Diurnal Variation of Corneal Dendritic Cell Density. Curr Eye Res 2022; 47:1239-1245. [PMID: 35726825 DOI: 10.1080/02713683.2022.2088799] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: To measure variation in corneal dendritic cell density, and percentage of mature to total dendritic cells, in healthy individuals during the sleep/wake cycle.Methods: Using in vivo confocal microscopy, images of the subbasal nerve plexus were captured from 19 healthy, noncontact lens wearing participants. The central cornea and inferior whorl were imaged three times (midday, before sleep, upon awakening). Dendritic cell counts from the images were categorized according to perceived maturity (immature vs mature). Dendritic cell density and percentage of mature to total cells were compared between time points.Result: The median and interquartile range (IQR) of total dendritic cell density in the central cornea was 32.0 (7.0-131.3) cells/mm2 at midday, 37.1 (8.2-103.9) cells/mm2 before sleep, and 19.5 (7.0-83.2) cells/mm2 on awakening. Corresponding values for immature cells were 28.1 (5.8-112.5) cells/mm2, 22.3 (7.4-84.0) cells/mm2 and 18.0 (2.9-64.8) cells/mm2, and for mature cells, 3.1 (0.0-6.6) cells/mm2, 2.0 (0.8-16.8) cells/mm2, and 1.6 (0.2-8.2) cells/mm2. At the inferior whorl, total dendritic cell density was 38.5 (18.4-84.5) cells/mm2, 34.4 (9.4-82.3) cell/mm2, and 32.3 (15.2-96.1) cells/mm2. Immature cell density was 32.8 (18.4-80.9) cells/mm2, 34.4 (8.6-81.0) cells/mm2, and 32.3 (12.6-78.5) cells/mm2. Mature cell density was 1.6 (0.0-6.3) cells/mm2, 1.6 (0.0-3.1) cells/mm2, and 1.8 (0.0-6.3) cells/mm2. There was no significant difference between time points for total cell density (p > 0.05), but the percentage of mature cells upon awakening was significantly greater, compared to midday, at the central cornea (p = 0.02).Conclusion: In healthy individuals, overall corneal dendritic cell density is reasonably constant during the sleep/wake cycle, but the relative number of mature cells tends to increase overnight.
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Affiliation(s)
- Sultan Alotaibi
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Department of Optometry and Vision Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jerome Ozkan
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Eric Papas
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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11
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Corneal Dendritic Cell Dynamics Are Associated with Clinical Factors in Type 1 Diabetes. J Clin Med 2022; 11:jcm11092611. [PMID: 35566743 PMCID: PMC9101330 DOI: 10.3390/jcm11092611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 01/11/2023] Open
Abstract
Time-lapsed in vivo corneal confocal microscopy (IVCCM) has shown that corneal dendritic cells (DCs) migrate at approximately 1 µm/min in healthy humans. We have undertaken IVCCM of the whorl region to compare the density of rounded DCs, and DCs with (wDCs) and without (woDCs) dendrites and dynamics; trajectory (length travelled/time), displacement (distance from origin to endpoint/time) speeds and persistence ratio (displacement/trajectory) of woDCs in subjects with type 1 diabetes (T1D) (n = 20) and healthy controls (n = 10). Only the wDC density was higher (p = 0.02) in subjects with T1D compared to controls. There was no significant difference in cell dynamics between subjects with T1D and controls. woDC density correlated directly with HDL cholesterol (r = 0.59, p = 0.007) and inversely with triglycerides (r = −0.61, p = 0.005), whilst round-shaped cell density correlated inversely with HDL cholesterol (r = −0.54, p = 0.007). Displacement, trajectory, and persistency correlated significantly with eGFR (mL/min) (r = 0.74, p < 0.001; r = 0.48, p = 0.031; r = 0.58, p = 0.008, respectively). We show an increase in wDC density but no change in any other DC sub-type or alteration in cell dynamics in T1D. However, there were associations between DC density and lipid parameters and between DC dynamics and renal function. IVCCM provides evidence of a link between immune cell dynamics with lipid levels and renal function.
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12
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Chiang JCB, Goldstein D, Tavakoli A, Trinh T, Klisser J, Lewis CR, Friedlander M, Naduvilath TJ, Au K, Park SB, Krishnan AV, Markoulli M. Corneal dendritic cells and the subbasal nerve plexus following neurotoxic treatment with oxaliplatin or paclitaxel. Sci Rep 2021; 11:22884. [PMID: 34819589 PMCID: PMC8613280 DOI: 10.1038/s41598-021-02439-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/08/2021] [Indexed: 02/08/2023] Open
Abstract
Immune cell infiltration has been implicated in neurotoxic chemotherapy for cancer treatment. However, our understanding of immune processes is still incomplete and current methods of observing immune cells are time consuming or invasive. Corneal dendritic cells are potent antigen-presenting cells and can be imaged with in-vivo corneal confocal microscopy. Corneal dendritic cell densities and nerve parameters in patients treated with neurotoxic chemotherapy were investigated. Patients treated for cancer with oxaliplatin (n = 39) or paclitaxel (n = 48), 3 to 24 months prior to assessment were recruited along with 40 healthy controls. Immature (ImDC), mature (MDC) and total dendritic cell densities (TotalDC), and corneal nerve parameters were analyzed from in-vivo corneal confocal microscopy images. ImDC was increased in the oxaliplatin group (Median, Md = 22.7 cells/mm2) compared to healthy controls (Md = 10.1 cells/mm2, p = 0.001), but not in the paclitaxel group (Md = 10.6 cells/mm2). ImDC was also associated with higher oxaliplatin cumulative dose (r = 0.33, p = 0.04) and treatment cycles (r = 0.40, p = 0.01). There was no significant difference in MDC between the three groups (p > 0.05). Corneal nerve parameters were reduced in both oxaliplatin and paclitaxel groups compared to healthy controls (p < 0.05). There is evidence of elevation of corneal ImDC in oxaliplatin-treated patients. Further investigation is required to explore this potential link through longitudinal studies and animal or laboratory-based immunohistochemical research.
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Affiliation(s)
- Jeremy Chung Bo Chiang
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Azadeh Tavakoli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Terry Trinh
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Jacob Klisser
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Thomas J Naduvilath
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Brien Holden Vision Institute, Sydney, NSW, Australia
| | - Kimberley Au
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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13
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Chinnery HR, Zhang XY, Wu CY, Downie LE. Corneal immune cell morphometry as an indicator of local and systemic pathology: A review. Clin Exp Ophthalmol 2021; 49:729-740. [PMID: 34240800 DOI: 10.1111/ceo.13972] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/26/2022]
Abstract
The corneal epithelium contains a population of resident immune cells commonly referred to as dendritic cells (DCs), or Langerhans cells. A unique advantage of the transparent cornea being situated at the surface of the eye is that these cells can be readily visualised using in vivo confocal microscopy. Over the past decade, interest in the involvement of corneal DCs in a range of ocular and systemic diseases has surged. For most studies, the number of corneal DCs has been the main outcome of interest. However, more recently attention has shifted towards understanding how DC morphology may provide insights into the inflammatory status of the cornea, and in some cases, the health of the peripheral nervous system. In this review, we provide examples of recent methodologies that have been used to classify and measure corneal DC morphology and discuss how this relates to local and systemic inflammatory conditions in humans and rodents.
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Affiliation(s)
- Holly R Chinnery
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Xin Yuan Zhang
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Ching Yi Wu
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
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14
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Chiang JCB, Goldstein D, Park SB, Krishnan AV, Markoulli M. Corneal nerve changes following treatment with neurotoxic anticancer drugs. Ocul Surf 2021; 21:221-237. [PMID: 34144206 DOI: 10.1016/j.jtos.2021.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/20/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
Survival rates of cancer has improved with the development of anticancer drugs including systemic chemotherapeutic agents. However, long-lasting side effects could impact treated patients. Neurotoxic anticancer drugs are specific agents which cause chemotherapy-induced peripheral neuropathy (CIPN), a debilitating condition that severely deteriorates quality of life of cancer patients and survivors. The ocular surface is also prone to neurotoxicity but investigation into the effects of neurotoxic chemotherapy on the ocular surface has been more limited compared to other systemic etiologies such as diabetes. There is also no standardized protocol for CIPN diagnosis with an absence of a reliable, objective method of observing nerve damage structurally. As the cornea is the most densely innervated region of the body, researchers have started to focus on corneal neuropathic changes that are associated with neurotoxic chemotherapy treatment. In-vivo corneal confocal microscopy enables rapid and objective structural imaging of ocular surface microscopic structures such as corneal nerves, while esthesiometers provide means of functional assessment by examining corneal sensitivity. The current article explores the current guidelines and gaps in our knowledge of CIPN diagnosis and the potential role of in-vivo corneal confocal microscopy as a diagnostic or prognostic tool. Corneal neuropathic changes with neurotoxic anticancer drugs from animal research progressing through to human clinical studies are also discussed, with a focus on how these data inform our understanding of CIPN.
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Affiliation(s)
- Jeremy Chung Bo Chiang
- School of Optometry & Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Maria Markoulli
- School of Optometry & Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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15
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Colorado LH, Dando SJ, Harkin DG, Edwards K. Label-free imaging of the kinetics of round-shaped immune cells in the human cornea using in vivo confocal microscopy. Clin Exp Ophthalmol 2021; 49:628-630. [PMID: 34081383 DOI: 10.1111/ceo.13954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Luisa H Colorado
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha J Dando
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Damien G Harkin
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katie Edwards
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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