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Abstract: Confocal microscopy in Sjogrens syndrome

Conjunctival in vivo Confocal Scanning Laser Microscopy in Patients with Sjogren Syndrome (SS).
Invest Ophthalmol Vis Sci. 2009 Aug 20. [Epub ahead of print]
Wakamatsu TH, Sato EA, Matsumoto Y, Ibrahim OM, Dogru M, Kaido M, Ishida R, Tsubota K.
Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

Purpose: To demonstrate the conjunctival alterations in patients with Sjögren's (SSDE) and non-Sjögren's syndrome dry eyes (NSSDE) using the HRTII/ RCM confocal microscope, in a prospective controlled study.

Methods: Twenty-eight right eyes from 28 SSDE patients (28 females; mean age: 58.2 +/- 14.3 years), seven right eyes from NSSDE patients (7 females; mean age: 66.1 +/- 14.4 years) and fourteen right eyes of 14 age and sex matched controls were studied. All subjects underwent Schirmer test, tear film break-up time (BUT), vital stainings and confocal microscopy of the temporal bulbar conjunctiva. The density of conjunctival epithelial cells, epithelial microcysts, conjunctival and corneal inflammatory infiltrates were also assessed.

Results: The tear quantity, stability and vital staining scores were significantly worse in patients with SSDE and NSSDE compared to control subjects (p<0.001 and p<0.05, respectively). Eyes of SSDE and NSSDE patients had a significantly higher density of conjunctival and corneal inflammatory infiltrates compared to eyes of controls (p<0.001). Conjunctival inflammatory cell densities showed a negative correlation with tear stability and tear quantity and a positive correlation with the vital staining scores. Conjunctival epithelial cell densities were significantly lower in SSDE and NSSDE compared with control subjects (p<0.05). The density of epithelial cysts was significantly higher in SS compared to healthy controls (p<0.001).

Conclusions: Confocal scanning laser microscopy was an efficient and a noninvasive tool for the quantitative assessment of the conjunctival inflammation and epithelial cell densities as well as evaluation of conjunctival morphological alterations such as microcysts in patients with SSDE and NSSDE dry eye disease.