Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneamicroscopically by laser-scanning confocal microscopy (IVCM). Slitlamp biomicroscopy was used to grade the stage of aniridia-relatedkeratopathy (ARK) based on degree of conjunctivalization of theperipheral and central cornea. By IVCM, specific limbal morphologyof epithelial cells, palisade ridges and projections was assessed.Results: Two eyes were found without clinical signs of ARK, and inthese eyes, the limbal palisades had a normal-appearing morphology.In the earliest stages of ARK where conjunctiva extended over thelimbal barrier, recognizable microscopic remnants of palisadestructures were apparent, but no normal-appearing palisade structureswere visible by IVCM. Limbal epithelial cells lost a regular mosaicand conjunctival-type epithelium invaded the limbal space. In all eyeswith later stages of ARK, conjunctivalization of the periphery orentire cornea was observed clinically, while no palisade structureswere present by IVCM. In a control group, normal limbal palisadesof Vogt structures were observed in the superior limbus in all eyes,but in five eyes in the inferior limbus normal palisades structureswere replaced by abnormal features.Conclusions: There appears to be a strong relationship of themicroscopic appearance of the limbal palisades of Vogt in aniridiaand the corresponding clinical degree of conjunctivalization of thecornea, which lends support to the theory that the palisades of Vogtrepresents a stem cell niche. IVCM could be a useful tool to assessearly morphologic changes that accompany stem cell deficiency.Commercial Relationships: Tor P. Utheim, None; Neil S. Lagali,None; Ulla Eden, None; Xiangjun Chen, None; Ruth Riise, None;Anette Dellby, None; Per Fagerholm, NoneSupport: Crown Princess Margareta’s Foundation for the VisuallyImpaired, Carmen and Bertil Regnérs Foundation for Research in EyeDisease, County Council of Östergötland, and Aniridia NorwayProgram Number: 2600 Poster Board Number: D0400Presentation Time: 2:45 PM - 4:30 PMLaser In Vivo Confocal Microscopy Demonstrates Diminishmentof Subbasal Nerve Plexus in Early Stage Fuchs EndothelialCorneal DystrophyShruti Aggarwal, Bernardo M. Cavalcanti, Andrea Cruzat, LauraRegali, Ula V. Jurkunas, Pedram Hamrah. Cornea, Ophthalmology,Massachusetts Eye& Ear Infirmary, Boston, MA.Purpose: To evaluate corneal sensation and subbasal nerve plexuschanges using laser in vivo confocal microscopy (IVCM) in early andlate stage Fuchs endothelial corneal dystrophy (FECD).Methods: A prospective, cross sectional study was conducted and 33FECD patients (33 eyes) were included. FECD patients wereclassified into early (without edema) and late stage (with edema).Fourteen eyes with pseudophakic bullous keratopathy (PBK) wereused as positive controls (edematous cornea) and 17 normal agematchedcontrols eyes as negative controls. IVCM (HRT3/RCM) wasperformed in the central cornea. Three representative images wereevaluated by masked 2 observers for density and number of subbasalnerves (NeuronJ), and presence of dendritic immunecells(DC)(ImageJ). Central corneal sensation was assessed byCochet-Bonnet esthesiometer.Results: Eyes with FECD and PBK showed significantly diminishedsubbasal nerves, including total nerve length (11.5±1.3 and2.8±0.7mm/mm2, respectively;p=0.001) and total number of nerves(8.8±1.1 and 2.2±0.4 n/frame;p=0.001), as compared to controls(23.3±8.1 mm/mm2 and 25.9±5.3 n/frame). Decreased nervescorresponded (R = 0.32) to diminished sensation in both FECD(4.9±0.2cm;p=0.045) and PBK (3.6±0.6;p=0.001) as compared tocontrols (5.9±0.04). Both early stage (n=22) and late stage FECD(n=11) showed significant reduction in total nerve density (13.1±1.4;9.9±1.2, respectively;) and number (8.2±2.5; 6.5±2.1), compared tocontrols (p100cells/mm2).Conclusions: IVCM demonstrates profound diminishment ofsubbasal nerves in both FECD and PBK, correlating to decreasedsensation. Interestingly, even early-stage FECD patients haddecreased subbasal nerves. Further, increased DC were found inpatients with FECD, demonstrating subclinical inflammation. Thedata suggests that reduction in subbasal nerves and inflammation maypotentially play a role in FECD. Additional studies are required toinvestigate whether subbasal nerve alterations are directly caused bydecreased endothelial cell density, or potentially lead to loss ofendothelial cells.Commercial Relationships: Shruti Aggarwal, None; Bernardo M.Cavalcanti, None; Andrea Cruzat, None; Laura Regali, None; UlaV. Jurkunas, 61/482,769 (P), Altheos (C); Pedram Hamrah, NoneSupport: Funding: NIH K08-EY020575, Research to PreventBlindness Career Development Award, Falk Medical Research Trust,New England Corneal Transplant Research FundProgram Number: 2601 Poster Board Number: D0401Presentation Time: 2:45 PM - 4:30 PMNew Diagnostic Parameters in Staging Limbal Stem CellDeficiency Using In Vivo Laser Scanning Confocal MicroscopyEric H. Chan 1 , Martin N. Nakatsu 2 , Sophie X. Deng 2 . 1 David GeffenSchool of Medicine at UCLA, Los Angeles, CA; 2 Cornea Division,Jules Stein Eye Institute, Los Angeles, CA.Purpose: To investigate the changes in corneal cytology andepithelium in different stages of LSCD using in vivo confocalmicroscopy (ICM) to establish a more accurate diagnostic algorithm.Methods: This was a prospective study, in which a total of 33 eyesdiagnosed clinically with LSCD were selected for ICM examinationand analyzed retrospectively. Of those 33 eyes, 20 eyes alsounderwent impression cytology. Ten normal eyes were included ascontrols for ICM examination. Confocal imaging of the centralcornea, the superior, nasal, inferior, and temporal limbus werecollected using the Heidelberg Retina Tomograph III RostockCorneal Module. Epithelial layer thickness, basal cell density, andbasal cell diameter were measured in images demonstrating clearepithelial cell morphology. Statistical analysis was evaluated usingANOVA, Kruskal-Wallis tests, and two-tailed T-tests.Results: Imaging of epithelial cell morphology in LSCD eyesrevealed prominent nuclei, loss of distinct cell borders, and generalloss of basal cells with and without preservation of subbasal nerves.In normal eyes, the average epithelial thickness measured by ICMwas 47.8 µm, 70.0 µm, 60.2 µm, 58.6 µm, and 62.2 µm in the centralcornea, inferior limbus, nasal limbus, superior limbus, and temporallimbus, respectively. When compared to respective normal limbuslocations, the epithelial thickness in the limbus affected by LSCDdecreased by 27% and 45% in early stage and intermediate stagedisease, respectively. Differences between early and intermediatechanges in epithelial thickness of the limbus were statisticallysignificant (p=0.04). Nine of the 20 eyes were positive for gobletcells on impression cytology. Goblet cells if present were foundirrespective of LSCD stage.Conclusions: Our data show that the limbal epithelium becomesprogressively thinner in advanced LSCD. Additionally, presence ofgoblet cells is not a reliable diagnostic marker of the early andintermediate stages of LSCD.©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.