Evaluation of Corneal Langerhans Cells in Patients with Thyroid Ophthalmopathy by Using an In vivo Confocal Microscopy: A Retrospective Study

Abstract

Objective: To assess corneal Langerhans cell (LC) density in thyroid-associated ophthalmopathy (TAO) patients to evaluate the role of inflammation in ocular surface disease related to TAO by using in vivo confocal microscopy (IVCM). Methods: Thirty-three patients who had inactive disease [(Clinical Activity Score (CAS)<3] and thirty age-matched healthy control subjects were enrolled in the study. All subjects underwent routine ophthalmologic examination including visual acuity levels, intraocular pressure, anterior segment, and posterior segment evaluation. The subjects were evaluated with tear break-up time (BUT). IVCM was performed to assess LC density in the central cornea. Also, correlation analyses of LC density and clinical data were performed. Results: The mean BUT was 9.61±5.01 seconds in the TAO group and 12.70±2.76 seconds in the control group (p=0.003). The median central corneal LC density in the control group was 19.00 (7.00-24.50) whereas it was significantly increased to 68.00 (50.00-92.00) in the TAO patients (p<0.001). In correlation analysis, there was a significant negative correlation between age and CAS of TAO patients (r=-0.348, p=0.047), and the age of TAO patients was not correlated with BUT and LC count (r=0.236, p=0.186 and r=-0.211, p=0.240, respectively). BUT of TAO patients was negatively correlated with LC count and CAS (r=-0.495, p=0.003 and r=-0.644, p<0.001, respectively). The CAS of the patients was not correlated with the LC count of the patients (r=0.261, p=0.143). In the control group, BUT, CAS and LC count was not correlated with each other. Conclusion: TAO patients in the inactive phase suffer from ocular surface inflammation and LC participates in corneal inflammation in TAO.

Keywords

• Langerhans cells
• ocular surface
• thyroid-associated ophthalmopathy
• in vivo confocal microscopy

Tiroid Oftalmopati Hastalarında In vivo Konfokal Mikroskopi Kullanılarak Langerhans Hücrelerinin Değerlendirilmesi: Retrospektif Bir Çalışma

Abstract

Amaç: Tiroid orbitopati (TAO) hastalarında görülen oküler yüzey hastalığında inflamasyonun rolünün in vivo konfokal mikroskopi (IVKM) ile korneal Langerhans hücre (LH) yoğunluğu araştırılarak değerlendirilmesi. Yöntem: Otuz üç inaktif hasta [(Klinik Aktivite Skoru (KAS)<3] ve otuz yaş uyumlu sağlıklı kontrol çalışmaya alındı. Tüm katılımcılara görme keskinliği seviyesi, göz içi basıncı, ön ve arka segment muayenesini içeren rutin oftalmik muayene yapıldı. Ayrıca gözyaşı kırılma zamanı (GKZ) da değerlendirildi. Santral korneada LH yoğunluğu IVKM ile değerlendirildi. Ayrıca, konfokal mikroskopi bulguları ile klinik verilerin korrelasyon analizi yapıldı. Bulgular: TAO grubunda ortalama GKZ 9,61±5,01 saniye, kontrol grubunda ise 12,70±2,76 saniye idi (p=0,003). Kontrol grubunda ortanca santral korneal LC yoğunluğu 19,00 (7,00-24,50) olmasına karşın TAO grubunda 68,00 (50,00-92,00)’e yükseldi (p<0,001). Korrelasyon analizinde TAO hastalarında yaş ve KAS arasında anlamlı negatif korrelasyon görüldü (r=-0,348, p=0,047) ve TAO hastalarının yaşı, GKZ ve LH sayısı ile korrele değildi (sırasıyla r=0,236, p=0,186 ve r=-0,211, p=0,240). TAO hastalarının GKZ değerleri LH sayısı ve KAS ile negatif korreleydi (sırasıyla r=-0,495, p=0,003 ve r=-0,644, p<0,001). Hastaların KAS ile LH sayısı korrelasyon göstermedi (r=0,261, p=0,143). Kontrol grubunda GKZ, KAS, LH sayısı birbiriyle korrele değildi. Sonuç: İnaktif fazdaki TAO hastalarında oküler yüzey inflamasyonu görülür ve LH, TAO hastalarında görülen korneal inflamasyonda görev alır.

Keywords

• Langerhans hücreleri
• oküler yüzey
• tiroid ilişkili oftalmopati
• in vivo konfokal mikroskopi

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