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

Yıl 2021, , 181 - 184, 29.05.2021

Büşra Yılmaz Tuğan

https://doi.org/10.30934/kusbed.915390

Cited By: 1

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Kishazi E, Dor M, Eperon S, Oberic A, Hamedani M, Turck N. Thyroid-associated orbitopathy and tears: A proteomics study. J Proteomics. 2018;170:110-116. doi:10.1016/j.jprot.2017.09.001
• Ismailova DS, Fedorov AA, Grusha YO. Ocular surface changes in thyroid eye disease. Orbit. 2013;32(2):87-90. doi:10.3109/01676830.2013.764440
• Selter JH, Gire AI, Sikder S. The relationship between Graves' ophthalmopathy and dry eye syndrome. Clin Ophthalmol. 2014;9:57-62. doi:10.2147/OPTH.S76583
• Iskeleli G, Karakoc Y, Abdula A. Tear film osmolarity in patients with thyroid ophthalmopathy. Jpn J Ophthalmol. 2008;52(4):323-326. doi:10.1007/s10384-008-0545-7
• Ujhelyi B, Gogolak P, Erdei A, Nagy V, Balazs E, Rajnavolgyi E et al. Graves' orbitopathy results in profound changes in tear composition: a study of plasminogen activator inhibitor-1 and seven cytokines. Thyroid. 2012;22(4):407-414. doi:10.1089/thy.2011.0248
• Gürdal C, Saraç O, Genç I, Kırımlıoğlu H, Takmaz T, Can I. Ocular surface and dry eye in Graves' disease. Curr Eye Res. 2011;36(1):8-13. doi:10.3109/02713683.2010.526285
• Rocha EM, Mantelli F, Nominato LF, Bonini S. Hormones and dry eye syndrome: an update on what we do and don't know. Curr Opin Ophthalmol. 2013;24(4):348-355. doi:10.1097/ICU.0b013e32836227bf
• Abusharaha A, Alturki AA, Alanazi SA, Fagehi R, Al-Johani N, El-Hiti GA, Masmali AM. Assessment of tear-evaporation rate in thyroid-gland patients. Clin Ophthalmol. 2019;13:131-135. doi:10.2147/OPTH.S188614
• Choi EY, Kang HG, Lee CH, Yeo A, Noh HM, Gu N et al. Langerhans cells prevent subbasal nerve damage and upregulate neurotrophic factors in dry eye disease. PLoS One. 2017;12(4):e0176153. doi:10.1371/journal.pone.0176153
• Hamrah P, Huq SO, Liu Y, Zhang Q, Dana MR. Corneal immunity is mediated by heterogeneous population of antigen-presenting cells. J Leukoc Biol. 2003;74(2):172-178. doi:10.1189/jlb.1102544
• Lin H, Li W, Dong N, Chen W, Liu J, Chen L et al. Changes in corneal epithelial layer inflammatory cells in aqueous tear-deficient dry eye. Invest Ophthalmol Vis Sci. 2010;51(1):122-128. doi:10.1167/iovs.09-3629
• Fiore T, Torroni G, Iaccheri B, Cerquaglia A, Lupidi M, Giansanti F et al. Confocal scanning laser microscopy in patients with postoperative endophthalmitis. Int Ophthalmol. 2019;39(5):1071-1079. doi:10.1007/s10792-018-0916-0
• Mandathara PS, Stapleton FJ, Kokkinakis J, Willcox MDP. A pilot study on corneal Langerhans cells in keratoconus. Cont Lens Anterior Eye. 2018;41(2):219-223. doi:10.1016/j.clae.2017.10.005
• Resch MD, Imre L, Tapaszto B, Nemeth J. Confocal microscopic evidence of increased Langerhans cell activity after corneal metal foreign body removal. Eur J Ophthalmol. 2008;18(5):703-707. doi:10.1177/112067210801800507
• Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C et al. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 2008;158(3):273-285. doi:10.1530/EJE-07-0666
• Marsovszky L, Resch MD, Németh J, Toldi G, Medgyesi E, Kovács L et al. In vivo confocal microscopic evaluation of corneal Langerhans cell density, and distribution and evaluation of dry eye in rheumatoid arthritis. Innate Immun. 2013;19(4):348-354. doi:10.1177/1753425912461677
• Villani E, Viola F, Sala R, Salvi M, Mapelli C, Currò N et al. Corneal involvement in Graves' orbitopathy: an in vivo confocal study. Invest Ophthalmol Vis Sci. 2010;51(9):4574-4578. doi:10.1167/iovs.10-5380
• Wei YH, Chen WL, Hu FR, Liao SL. In vivo confocal microscopy of bulbar conjunctiva in patients with Graves' ophthalmopathy. J Formos Med Assoc. 2015;114(10):965-972. doi:10.1016/j.jfma.2013.10.003
• Wu LQ, Cheng JW, Cai JP, Le QH, Ma XY, Gao LD et al. Observation of Corneal Langerhans Cells by In Vivo Confocal Microscopy in Thyroid-Associated Ophthalmopathy. Curr Eye Res. 2016;41(7):927-932. doi:10.3109/02713683.2015.1133833
• Lin H, Li W, Dong N, Chen W, Liu J, Chen L et al. Changes in corneal epithelial layer inflammatory cells in aqueous tear-deficient dry eye. Invest Ophthalmol Vis Sci. 2010;51(1):122-128. doi:10.1167/iovs.09-3629
• Marsovszky L, Németh J, Resch MD, Toldi G, Legány N, Kovács L et al. Corneal Langerhans cell and dry eye examinations in ankylosing spondylitis. Innate Immun. 2014;20(5):471-477. doi:10.1177/1753425913498912