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Corneal features in ocular graft-versus-host disease by in vivo confocal microscopy

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Abstract

Purpose

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).

Methods

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.

Results

IVCM images obtained from 66 eyes were analyzed. The density of superficial epithelial cells was 636.07 ± 101.05 cells/mm2 in the oGVHD group, 827 ± 99.62 cells/mm2 in the DES group and 1277.2 ± 121.42 cells/mm2 in the control group (P < 0.001). The density of wing cells was 4499.79 ± 976.36 cells/mm2 in the oGVHD group, 4662.85 ± 319.72 cells/mm2 in DES group and 6556.38 ± 503.99 cells/mm2 in the control group (p < 0.001). The density of basal cells was 7850.93 ± 723.51 cells/mm2 in the oGVHD group, 8570 ± 913.32 cells/mm2 in DES group and 9759.8 ± 251.99 cells/mm2 in the control group (p < 0.01). The density of nerve fibers was 11.22 ± 5.46 mm/mm2 in the oGVHD group, 14.50 ± 4.27 mm/mm2 in DES group and 19.56 ± 4.75 mm/mm2 in the control group (p < 0.01). The DC density was 67.88 ± 71.82 cells/mm2 in the oGVHD group, 40.06 ± 31.95 cells/mm2 in the DES group and 29.45 ± 8.1 cells/mm2 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.

Conclusions

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.

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Authors and Affiliations

  1. Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, DVRC 211, Los Angeles, CA, 90033, USA

    Tudor C. Tepelus, Jyotsna Maram, Jianyan Huang, Vikas Chopra, SriniVas R. Sadda & Olivia L. Lee

  2. Department of Ophthalmology, David Geffen School of Medicine at UCLA, 100 Stein Plaza UCLA, Los Angeles, CA, 90095, USA

    Tudor C. Tepelus, Jianyan Huang, Vikas Chopra, SriniVas R. Sadda & Olivia L. Lee

  3. USC Roski Eye Institute, Keck School of Medicine, 1450 San Pablo Street, Los Angeles, CA, 90033, USA

    Gloria B. Chiu

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Correspondence to Olivia L. Lee.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Tepelus, T.C., Chiu, G.B., Maram, J. et al. Corneal features in ocular graft-versus-host disease by in vivo confocal microscopy. Graefes Arch Clin Exp Ophthalmol 255, 2389–2397 (2017). https://doi.org/10.1007/s00417-017-3759-x

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  • DOI: https://doi.org/10.1007/s00417-017-3759-x

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