Purpose

To evaluate corneal immune dendritiform cell (DC) changes in dry eye disease (DED) using in vivo confocal microscopy (IVCM) and to correlate IVCM parameters with clinical severity.

Methods

This was a retrospective, cross-sectional study including 300 eyes of 150 DED patients and 49 eyes of 49 age-matched controls. Severity of DED was based on the Dry Eye Workshop (DEWS) classification. IVCM images of subbasal layer of the central cornea were analyzed for DC density and morphology (including number of dendrites per DC, DC size and DC field).

Results

DC density was significantly higher in DED compared to controls (93.4 ± 6.3 vs. 25.9 ± 3.9 cells/mm [2]; P < 0.001). Morphologically, number of dendrites, DC size and field were significantly larger in DED (3.3 ± 0.1, 106.9 ± 4.7 μm [2], 403.8 ± 20.1 μm [2] than controls (2.3 ± 0.1, 62.5 ± 5.7 μm [2], 241.4 ± 24.4 μm [2], P < 0.001). Significantly higher DC density compared to controls was observed as early as Level 1 DED severity (87 ± 10 cells/mm [2], p < 0.001. Significant morphological changes in DC were detected for Levels 2 to 4 (p=<0.001, and p = 0 < 0.05) for dendrites and DC field, respectively. Similarly, DC size showed significant increase at DED level 3–4. (p < 0.05). Linear regression analysis showed that both conjunctival and corneal staining were independently associated with DC density, while corneal staining was independently associated with DC morphology.

Conclusion

DC density and morphology correlated with clinical severity of DED. While, DC density is increased in mild DED, morphological changes are seen only in severe cases. IVCM may be a powerful tool to detect early immune changes and may complement clinical examination in DED.

中文翻译：

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角膜免疫细胞变化与干眼病临床严重程度的相关性：体内共聚焦显微镜研究。

目的

使用体内共聚焦显微镜 (IVCM) 评估干眼病 (DED) 中角膜免疫树突状细胞 (DC) 的变化，并将 IVCM 参数与临床严重程度相关联。

方法

这是一项回顾性横断面研究，包括 150 名 DED 患者的 300 只眼和 49 名年龄匹配的对照组的 49 只眼。DED 的严重程度基于干眼研讨会 (DEWS) 分类。分析中央角膜基底层的 IVCM 图像的 DC 密度和形态（包括每个 DC 的树突数量、DC 大小和 DC 场）。

结果

与对照组相比，DED 中的 DC 密度显着更高（93.4 ± 6.3 vs. 25.9 ± 3.9 个细胞/mm [2]；P < 0.001）。在形态学上，DED 中的树突数量、DC 大小和场明显大于对照（3.3 ± 0.1、106.9 ± 4.7 μm [2]、403.8 ± 20.1 μm [2]）（2.3 ± 0.1、62.5 ± 5.7 μm [2]、 241.4 ± 24.4 μm [2]，P < 0.001。早在 1 级 DED 严重性（87 ± 10 个细胞/mm [2]，p < 0.001。DC 的显着形态变化是分别检测到树突和 DC 场的 2 至 4 级（p = <0.001，和 p = 0 < 0.05）。同样，DC 大小在 DED 3-4 级显示显着增加。（p < 0.05）。线性回归分析表明结膜和角膜染色均与 DC 密度独立相关，

结论

DC 密度和形态与 DED 的临床严重程度相关。虽然轻度 DED 中 DC 密度增加，但仅在严重情况下才会出现形态变化。IVCM 可能是检测早期免疫变化的强大工具，可以补充 DED 的临床检查。