Bernardo Cavalcanti, MD is a post-doctoral research fellow at the Cornea Service and the Ocular Surface Imaging Center of the Massachusetts Eye and Ear Infirmary, Harvard Medical School in Boston, MA. Candice Williams, BSc is a clinical research technician at the Cornea Service and the Ocular Surface Imaging Center of the Massachusetts Eye and Ear Infirmary, Harvard Medical School in Boston, MA. Their work is based on the development of new in vivo confocal imaging of the ocular surface inflammation supported by Dr. Pedram Hamrah's lab at the Schepens Eye Research Institute.
Download the poster, which was originally shared at the Association for Research in Vision & Ophthalmology (ARVO) annual meeting, 2012.
In Vivo Confocal Microscopy as a Tool to Evaluate Cellular Changes in the Cornea and Conjunctiva in Ocular Allergy and Non-Allergic Ocular Inflammatory Diseases
Candice Williams1,2, Bernardo Cavalcanti1,2, Andrea Cruzat1,2, Monique Trinidad1,2, Yesim Haussler-Sinangin2, Reza Dana2, Pedram Hamrah1,2.
1Ocular Surface Imaging Center, 2Cornea Service, Massachusetts Eye & Ear Infirmary, Harvard Department of Ophthalmology, Boston, MA.
Purpose: To evaluate cellular changes on the conjunctiva and cornea in patients with ocular allergy and non-allergic ocular inflammatory diseases (OID) by in vivo confocal microscopy (IVCM).
Methods: Laser IVCM (HRT3/RCM) of the conjunctiva, central and peripheral cornea was performed in 6 patients (8 eyes) with ocular allergy (OA), 9 patients (10 eyes) with OID, and 6 control subjects (8 eyes) between March 2010 and September 2011. Images for each area were quantified for dendritic (DC) and non-dendritic immune cells (IC) density. Cellular and cell border reflectivity of superficial epithelial cells (SE) were evaluated. Conjunctival vessels were assessed for presence and location of immune cells.
Results: Patients with OA and OID demonstrated increased hyperreflectivity of corneal (71% and 78%) and conjunctival SE (63% and 42%) as compared to controls (0%). SE cell border reflectivity in the area of tight junctions was increased in the cornea for OA and OID (83%) and the conjunctiva (77% OA; 70% OID) compared to controls (0% cornea; 11% conjunctiva). While central corneal DC density was lower in acute OA (46.8±31 cells/mm2) vs. acute OID (83.7±37) cases, patients with chronic OA (256.3±243) had higher DC density compared to chronic OID (65.6±56; p<0.05). In the peripheral cornea, a 35% (acute OA) and 90% (chronic OA) increase in DC density was observed as compared to controls. Moreover, conjunctival DC density was significantly increased in both OA (131.2±100) and OID (234.4±206) as compared to controls (17.5±16.2; p<0.05). Finally, conjunctival vessels demonstrated increased immune cell adhesion in OA (5.5±0.7 cells/100μm vessel length) and OID (5.7±1.7) compared to controls (0.13±0.35; p<0.05).
Conclusion: IVCM demonstrates profound immune and inflammatory changes in ocular allergic and non-allergic ocular inflammatory diseases. IVCM also shows superficial epithelial cell changes in the cornea and conjunctiva epithelium of patients with both OA and OID. IVCM provides a powerful platform for the evaluation of the ocular surface beyond slit-lamp examination and may provide a tool for patient stratification and objective assessment of treatment response in clinical trials through sensitive imaging biomarkers.