Tepelus Tudor C, Chiu Gloria B, Maram Jyotsna, Huang Jianyan, Chopra Vikas, Sadda SriniVas R, Lee Olivia L
Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, DVRC 211, Los Angeles, CA, 90033, USA.
Department of Ophthalmology, David Geffen School of Medicine at UCLA, 100 Stein Plaza UCLA, Los Angeles, CA, 90095, USA.
Graefes Arch Clin Exp Ophthalmol. 2017 Dec;255(12):2389-2397. doi: 10.1007/s00417-017-3759-x. Epub 2017 Sep 5.
The purpose of our study was to determine the morphological features of the corneal epithelial layers, sub-basal nerve plexus and anterior stroma in patients with ocular graft-versus-host disease (oGVHD) compared to non-GVHD dry eyes and normal controls, using in vivo confocal microscopy (IVCM).
IVCM was used to capture central cornea images from eight volunteers with normal healthy eyes, ten patients with non-GVHD dry eye syndrome (DES) and 15 patients with clinically diagnosed oGVHD, in a cross-sectional study. Morphological changes of the corneal epithelial layers and anterior stroma, characteristics of corneal nerves and presence of dendritic cells (DCs) were then evaluated.
IVCM images obtained from 66 eyes were analyzed. The density of superficial epithelial cells was 636.07 ± 101.05 cells/mm in the oGVHD group, 827 ± 99.62 cells/mm in the DES group and 1277.2 ± 121.42 cells/mm in the control group (P < 0.001). The density of wing cells was 4499.79 ± 976.36 cells/mm in the oGVHD group, 4662.85 ± 319.72 cells/mm in DES group and 6556.38 ± 503.99 cells/mm in the control group (p < 0.001). The density of basal cells was 7850.93 ± 723.51 cells/mm in the oGVHD group, 8570 ± 913.32 cells/mm in DES group and 9759.8 ± 251.99 cells/mm in the control group (p < 0.01). The density of nerve fibers was 11.22 ± 5.46 mm/mm in the oGVHD group, 14.50 ± 4.27 mm/mm in DES group and 19.56 ± 4.75 mm/mm in the control group (p < 0.01). The DC density was 67.88 ± 71.82 cells/mm in the oGVHD group, 40.06 ± 31.95 cells/mm in the DES group and 29.45 ± 8.1 cells/mm in the control group (P > 0.05). Visible networks of activated keratocytes were seen in the anterior stroma of eyes with oGVHD and DES, but not in normal controls.
IVCM revealed distinct microstructural changes in the corneas of patients with oGVHD and DES, similar between the two groups. Our findings suggest implications for use of IVCM to evaluate and monitor patients with dry eyes associated or not with GVHD.
我们研究的目的是使用共聚焦显微镜（IVCM），确定与非移植物抗宿主病（GVHD）干眼症患者及正常对照相比，眼部移植物抗宿主病（oGVHD）患者角膜上皮层、基底神经丛和前基质的形态学特征。
在一项横断面研究中，使用IVCM从8名健康志愿者、10名非GVHD干眼症综合征（DES）患者和15名临床诊断为oGVHD的患者中获取中央角膜图像。然后评估角膜上皮层和前基质的形态学变化、角膜神经特征以及树突状细胞（DC）的存在情况。
对从66只眼中获得的IVCM图像进行了分析。oGVHD组浅表上皮细胞密度为636.07±101.05个细胞/mm，DES组为827±99.62个细胞/mm，对照组为1277.2±121.42个细胞/mm（P<0.001）。oGVHD组翼状细胞密度为4499.79±976.36个细胞/mm，DES组为4662.85±319.72个细胞/mm，对照组为6556.38±503.99个细胞/mm（p<0.001）。oGVHD组基底细胞密度为7850.93±723.51个细胞/mm，DES组为8570±913.32个细胞/mm，对照组为9759.8±251.99个细胞/mm（p<0.01）。oGVHD组神经纤维密度为11.22±5.46mm/mm，DES组为14.50±4.27mm/mm，对照组为19.56±4.75mm/mm（p<0.01）。oGVHD组DC密度为67.88±71.82个细胞/mm，DES组为40.06±31.95个细胞/mm，对照组为29.45±8.1个细胞/mm（P>0.05）。在oGVHD和DES患者的眼前基质中可见活化角膜细胞的可见网络，但在正常对照中未见。
IVCM显示oGVHD和DES患者角膜存在明显的微观结构变化，两组相似。我们的研究结果表明IVCM在评估和监测与GVHD相关或不相关的干眼症患者方面具有应用价值。
