An In Vivo Study On Corneals Of Patients With Sj(?)gren Syndrome By Laser Confocal Microscopy

Background: Sjogren syndrome is a disease of immune self, it damages the spittle gland and tear gland, the most common sympomes of SS are dry eye and dry mouth. Female patients are commonly seen. The illness rate is 0.29% to 0.77% in Chinese. About 10% of dry eye are coursed by Sjogren syndrome.Purpose: To investigate the alteration of corneal epithelium and nerves in patients with Sjogren syndrome(SS) by laser Confocal microscopy.Method: 22 patients with SS and 15 healthy volunteers were investigated by HRT- II laser Confocal microscopy, the courses of disease were from 6 months to 36 months. The main parameters for analyzing were the number( defined as the sum of the nerve branches present in one image), density( defined as the total length of the nerve fibers observed in one image), grade of tortuosity( classified in four grades according to a scale), and the branching pattern( evaluated as positive if at least one branching pattern was present within an image or negative if not. of nerve). We measured their corneal sensitivity at the same time. Statistical Analysis: the results of right eyes were choused to analyze, t-test, ANOVA, Fisher -test and Person-test were used to analyze deferent dates, and SPSS 13.0 were used in our study. p≤0.05 was considered statistically significant.Result: 1.The changes of the corneal epithelial cell occurred on SS can be observed: irregular cell shape, loose cell link, small cyst, and even dissipated. 2. The shape of the epithelial cells were irregular, and even erosion can be seen in SS patients. There was no significant difference between the tow groups(p>0.05) in the density of basal epithelial cell. 3. Compared with normal controls, the subbasal nerve tortuosity increased significantly in SS group(p=0.003). In addition, the nerve branching appeared more frequently in SS patients(p=0.040).What's more, the increased nerve number and density were observed in SS group (p=0.000,p=0.038). 4. SS patients showed a significant decrease in corneal sensitivity comparing with normal person(p=0.000). 5. A negative correlation was found between the tortuosity and corneal sensitivity(p=0.020) by using Person correlation analysis.Conclusion: Alternations have occurred on the patients' corneal epithelium and nerves with SS, and these changes cannot be found by ways in common use. Laser Confocal microscopy can provide more clear and exact images on histology. What's more, the examine is fast, atraumatic, real time, fast, exact on position fixing, and can be made repeatedly. So, it's valuable on basic research, early diagnosis, pathogenesis finding and pathology investigation of corneal diseases.