In vivoconfocal microscopic evaluation of corneal Langerhans cell density, and distribution and evaluation of dry eye in rheumatoid arthritis

Abstract

Corneal Langerhans cells (LCs) offer the opportunity to gain insight into the activity of the innate immunity. We examined the density and the distribution of LCs and compared the results with dry-eye parameters in rheumatoid arthritis (RA). Fifty-two RA patients with various degrees of disease activity and 24 healthy subjects were enrolled. Peripheral and central LC number and morphology were assessed with in vivo laser confocal microscopy. In addition, ocular surface disease index (OSDI), lid parallel conjunctival folds, Schirmer test, and tear break-up time (TBUT) were evaluated. The prevalence of central and peripheral LC, and the central LC morphology values (LCM) were higher than normal in RA. Within the RA group, LC prevalence and morphology were not affected by disease activity. However, patients on anti-TNF or glucocorticosteroid (GCS) therapy exhibited normal LCM, and normal central and peripheral LC density. OSDI was higher and TBUT was lower than normal in RA. The alteration of LC in RA suggests an active inflammatory process in the cornea, which may reflect an increased activation state of the innate immune system-even in inactive stages of RA and without ocular symptoms. The results also indicate ocular effects of GCS therapy in RA.

In Vivo Confocal Microscopy in Dry Eye Disease Associated With Chronic Graft-Versus-Host Disease

“…Such a discrepancy, commonly seen in DED, 21,22 may partly be explained by a reduced corneal sensation in GVHD, as has been reported before, 10 as well as a decreased corneal nerve density, as discussed below. Compared with corneal epithelial DC density in healthy controls (14.5-34.0 cells/mm 2 ), 23,24 overall our patients had a higher corneal epithelial DC density; however, there was no significant difference between the GVHD group (148 cells/ mm 2 ) and the non-GVHD group (122 cells/mm 2 ). Steger and colleagues 25 also have compared 12 patients with severe DED due to GVHD to 6 patients without GVHD (5 before and 1 after HSCT) and also found no significant difference in corneal epithelial DC density between these two groups.…”

Efficiency and safety of subconjunctival injection of anti-VEGF agent – bevacizumab – in treating dry eye

“…Enríquez-de-Salamanca et al24 indicated that the expression of proinflammatory factors was negatively correlated with TBUT. Marsovszky et al25 also demonstrated that active inflammation of the ocular surface of the patients with rheumatoid arthritis could decrease the TBUT level. In our research, the longer TBUT after the injection may be the result of the inhibition effect of the anti-VEGF therapy on the expression and activation of the proinflammatory factors, thereby depressing the ocular surface inflammation.…”

In Vivo Confocal Microscopic Evaluation of Corneal Langerhans Cells in Dry Eye Patients§

“…Marsovszky L. et al . [ 21 ] found a prevalence of central and peripheral LCs - together with central LCs morphology values - significantly higher than normal in patients affected by rheumatoid arthritis. This alteration of LCs in rheumatoid arthritis suggests an active inflammatory process in the cornea, which may reflect an increased activation state of the innate immune system, even in inactive stages of the disease and without ocular symptoms.…”