In Vivo Confocal Laser Microscopy Of Bulbar Conjunctiva In Patients With Aqueous Tear Deficiency Dry Eye

ObjectiveTo observe the bulbar conjunctiva morphological abnormalities in patients with aqueous tear deficiency(ATD) dry eye by laser confocal microscopy, and study the vivo conjunctiva pathological features in Patients with ATD dry eye, to provide a diagnosis and treatment for ATD dye eye in vivo cell level.Methods30 eyes of 30 patients(including 2 eyes of 2 SS-ATD) were collected,12 of which were male,18 were female, and the mean age was (38.43±11.72) years; 22 eyes of 18 healthy volunteers were collected at equal pace,7 of which were male,11 were female, and the mean age was (37.50±11.87) years. The gender and age were insignificant differences of two groups(P=0.939, P=0.919). Every patients was inquired of the family and past history, then a biomicroscopic examination, tear break-up time, schirmer test and rose staining was performed. Laser scanning confocal microscopy was used to examine the morphological characteristics of the bulbar conjunctiva in the subjects. The parameters of confocal microscopy were as follows:resolution 1μm, wave length 670 nm, field range 400μm×400μm. The epithelial cell numbers, dendritic cells density and goblet cells density from superior, inferonasal, nasal and temporal bulbar conjunctiva were calculated respectively and imaged by the HRT3 Rostock Cornea Modual. The statistical software was SPSS17.0, P<0.05 was considered statistically significant.Results1. The superficial epithelial cells of the bulbar conjunctiva was seen with the small cell nuclei and blur border. The borders of basal epithelial cell were clearly visible without cell nuclei. The presumed goblet cell presented with a large hyperreflective oval-shaped cell with relatively homogeneous brightness, crowed in groups or mainly dispersed. The orfices at the epithelial surface represented the goblet cells, showing some open and expel contents. The dendritic cell appeared to be hyperreflective corpuscular particles with visible processes among conjunctival epithelial cells. A few dense white fiber meshwork was exhibited in conjunctival stroma with the traverse blood vessels containing cellular elements. The size of epithelial cell in ATD group was differ, along with inflammatory cell infiltration, the desquamation epithelium cells and microcyst structure were found in two groups, and there were insignificant differences of cell morphous between the two groups.2. The tear quantity, stability, and rose staining scores were significantly worse in patients with ATD than in control subjects (P<0.001, respectively). In four location of ATD group, the mean density of superficial epithelial cell, basal epithelial cell, goblet cell and dendritic cell were (1894±573)/mm2, (2781±722)/mm2, (34±27)/mm2 and (83±33)/mm2; In four location of control group, the mean density of superficial epithelial cell, basal epithelial cell, goblet cell and dendritic cell were (2545±688)/mm2, (2965±398)/mm2, (79±44)/mm2 and (96±25)/mm2. By statistics analyze, there was no significant difference in the mean density of the superficial epithelial cell between two groups; significant difference were proved in the mean density of the basal epithelial cell, the ATD group lower than control group(P<0.001), further to contrast, the superior and temporal cell density of ATD group were lower than control group, significant differences were proved(superior:P<0.01, temporal:P=0.001); significant difference were proved in the mean density of the goblet cell, the ATD group lower than control group(P<0.001), further to contrast, the nasal cell density of ATD group were lower than control group, significant differences were proved(P<0.001); significant difference were proved in the mean density of the dendritic cell, the ATD group more than control group(P=0.001), dendritic cell was not found in the control group, further to contrast, the nasal cell density of ATD group were more than control group, significant differences were proved(P<0.001).ConclusionsLaser scanning confocal microscopy is a powerful technique for studying the vivo bulbar conjunctiva in cell level. We found the cell density of basal epithelial cell and goblet cell in the bubar conjunctiva were decrease in patients of ATD dry eye, but dendritic cell was increase. We observed and contrasted the cell quantitative alternation of bulbar conjunctiva in four different location of ATD patients at first time, to provide evidence for pathological change of dry eye.