The Ocular Surface in Medically Controlled Glaucoma: An In Vivo Confocal Study

Sacchi, Matteo; Magnani, Fabrizio; Nicodemo, Angelo; Williams, Susan E.; Rossi, Alessandro; Ratiglia, Roberto; Cillà, Stefano De; Nucci, Paolo

doi:10.1167/iovs.15-17455

Cited by 39 publications

(51 citation statements)

References 63 publications

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“…GCs were recognized in all enrolled participants and their morphological features were consistent with those reported in other confocal studies (21)(22)(23). They appeared as large cellular elements, hyper-reflective and oval-shaped, containing hyporeflective nuclei; their dimensions were greater than those of the surrounding epithelial cells, occasionally crowded in groups or dispersed within the epithelial layer of the conjunctiva, at 20-30 μm depth (Figure 1).…”

Section: Resultssupporting

confidence: 85%

“…Twelve high-quality images, without motion blur or compression lines, were selected from the three conjunctival sectors (superior nasal, superior central, superior temporal) to calculate the number of GCs using Cell Count Software (Heidelberg Engineering GmbH) in manual mode. This definition was adopted taking into account reference images and the morphological characterization, in vivo 32: 437-443 (2018) as previously reported in the literature (21)(22)(23). The total confocal examination session lasted 10 min and none of the patients experienced particular complications at the end of the session.…”

Section: Methodsmentioning

confidence: 99%

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In Vivo Scanning Laser Confocal Microscopy of Conjunctival Goblet Cells in Medically-controlled Glaucoma

Staso

Agnifili

Ciancaglini

et al. 2018

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Section: Resultssupporting

confidence: 85%

Section: Methodsmentioning

confidence: 99%

In Vivo Scanning Laser Confocal Microscopy of Conjunctival Goblet Cells in Medically-controlled Glaucoma

Staso

Agnifili

Ciancaglini

et al. 2018

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“…183,233 Rossi et al confirmed the lessened side effects in corneal nerves of preservative-free antiglaucoma drops after 1 year of treatment, showing that previously treated patients had an improvement in number of corneal nerves and tortuosity and that naïve patients did not show significant changes with the preservative-free medication. 235 Villani et al 236 showed that in stable primary open-angle glaucoma patients without a history of DED, there are subclinical ocular surface changes due to antiglaucoma medications. Interestingly, they observed increased subbasal nerve length and tortuosity, as well as dendritic cell density, compared to controls.…”

Section: Correlation Of Corneal Nerve Alterations To Corneal Sensmentioning

confidence: 99%

In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease

2017

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In vivo confocal microscopy (IVCM) is becoming an indispensable tool for studying corneal physiology and disease. Enabling the dissection of corneal architecture at a cellular level, this technique offers fast and noninvasive in vivo imaging of the cornea with images comparable to that of ex vivo histochemical techniques. Corneal nerves bear substantial relevance to clinicians and scientists alike, given their pivotal roles in regulation of corneal sensation, maintenance of epithelial integrity, and proliferation and promotion of wound healing. Thus, IVCM offers a unique method to study corneal nerve alterations in a myriad of conditions, such as ocular and systemic diseases and following corneal surgery, without altering the tissue microenvironment. Of particular interest has been the correlation of corneal subbasal nerves to their function, which has been studied in normal eyes, contact lens wearers, and patients with keratoconus, infectious keratitis, corneal dystrophies, and neurotrophic keratopathy. Longitudinal studies have applied IVCM to investigate the effects of corneal surgery on nerves, demonstrating their regenerative capacity. IVCM is increasingly important in the diagnosis and management of systemic conditions such as peripheral diabetic neuropathy and, more recently, in ocular diseases. In this review, we outline the principles and applications of IVCM in the study of corneal nerves in various ocular and systemic diseases.

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“…In a study by Villani et al [36] on medically controlled POAG, 100 eyes were evaluated by HRT 2 RCM (Heidelberg Engineering GmbH, Heidelberg, Germany) and compared to healthy controls. Previously validated confocal parameters associated with characteristics of the therapeutic regimen were studied in addition to DC density [36].…”

mentioning

confidence: 99%

“…Previously validated confocal parameters associated with characteristics of the therapeutic regimen were studied in addition to DC density [36]. The authors also concluded that alone, or in combination, A/G topical medication had been found to change the ocular surface confocal parameters.…”

mentioning

confidence: 99%

Assessment of Corneal Changes Associated with Topical Antiglaucoma Therapy Using in vivo Confocal Microscopy

et al. 2018

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Purpose: Ocular surface disease (OSD) is highly prevalent in eyes treated with chronic, topical antiglaucoma (A/G) therapy. The purpose of this study was to utilize in vivo confocal microscopy (IVCM) to evaluate the corneal morphology, including characteristics of corneal epithelial cells, presence of epithelial dendritic cells (DCs), and characteristics of subbasal nerve plexus, of eyes under topical A/G therapy versus normal eyes. Methods: Central corneal images were prospectively captured from 30 eyes of 16 patients under topical A/G therapy (>6 months) and 20 normal control eyes, using IVCM (HRT 3 RCM, Heidelberg, Germany). Demographic data were collected, as well as information on the types and duration of A/G therapy. In addition, OSD index (OSDI) score, tear film breakup time, Schirmer 1 test results, density of epithelial wing cells (WCs) and basal cells (BCs), subbasal nerve features (density, tortuosity, and reflectivity), and presence of DCs were all assessed and recorded by trained Doheny Image Reading Center graders. Results: IVCM findings of 30 glaucomatous eyes and 20 normal control eyes were analyzed. The mean OSDI score was 8.72 in controls and 32.06 in patients under A/G therapy (p = 0.002). Nerve fiber density, nerve fiber reflectivity, and BC density were all decreased in the A/G group (1,789.07 ± 785.70 μm/frame, 2.79 ± 0.83, 6,457.67 ± 692.55 cells/mm², respectively) as compared to controls (2,815.981 ± 563.77 μm/frame, 3.52 ± 0.50, 7,854.13 ± 1,073.69 cells/mm², respectively) (p < 0.05), whereas the decrease in WC density was statistically nonsignificant (p = 0.5). Nerve tortuosity and DC density were both significantly greater in the A/G eyes (3.00 ± 0.57, 71.24 ± 61.74 cells/mm², respectively) compared to controls (2.10 ± 0.42, 34.08 ± 11.70 cells/mm², respectively) (p < 0.05). Tear film breakup time and Schirmer 1 test results were significantly lower in the A/G group as compared to controls (p < 0.001). Conclusions: Using IVCM, our study identified significant microstructural alterations in the corneas of eyes treated with topical A/G therapy. In addition, our study also revealed that glaucoma patients treated with topical A/G therapy report significantly higher OSDI scores compared to controls. Thus, IVCM may be a useful tool in providing structural parameters to correlate with the functional OSDI assessments in the evaluation of ocular surface toxicity associated with topical A/G therapy.

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The Ocular Surface in Medically Controlled Glaucoma: An In Vivo Confocal Study

Cited by 39 publications

References 63 publications

In Vivo Scanning Laser Confocal Microscopy of Conjunctival Goblet Cells in Medically-controlled Glaucoma

In Vivo Scanning Laser Confocal Microscopy of Conjunctival Goblet Cells in Medically-controlled Glaucoma

In Vivo Confocal Microscopy of Corneal Nerves in Health and Disease

Assessment of Corneal Changes Associated with Topical Antiglaucoma Therapy Using in vivo Confocal Microscopy

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