An essential role for dendritic cells in vernal keratoconjunctivitis: analysis by laser scanning confocal microscopy

Abstract

In vivo confocal microscopy appears to be a valuable tool in evaluating the dynamic change of DCs at the conjunctiva and cornea. DCs play an essential role in VKC and therefore may constitute a target for therapeutic intervention for VKC.

Therapeutic Effect of 0.1% Tacrolimus Eye Drops in the Tarsal Form of Vernal Keratoconjunctivitis

“…Montan et al [2] found that conjunctival biopsy specimens taken from patients with VKC showed higher counts for dendritic cell markers, including HLA-DR (MHC class II), FcεRI, and CD1a, than in healthy control subjects. Large numbers of dendritic cells distributed in the bulbar conjunctiva, limbus, and peripheral cornea of VKC have also been discovered on in vivo confocal microscopy [23]. Dendritic cells are crucial in determining the nature of an allergic response and are believed to play a major role in the pathogenesis of VKC [23][24][25].…”

“…Large numbers of dendritic cells distributed in the bulbar conjunctiva, limbus, and peripheral cornea of VKC have also been discovered on in vivo confocal microscopy [23]. Dendritic cells are crucial in determining the nature of an allergic response and are believed to play a major role in the pathogenesis of VKC [23][24][25]. Tacrolimus is a potent immunosuppressive agent, which causes marked suppression of the production of various cytokines by the activated T cells involved in the pathogenesis of VKC [26,27].…”

“…Conjunctival cytology studies also show that topical tacrolimus is very effective in reducing numbers of inflammatory cells; it is reported to inhibit calcineurin 100 times more effectively than cyclosporine [28,29]. Liu et al [23] detected that topical use of corticosteroids and cyclosporine can efficiently change the number and maturation state of dendritic cells at the conjunctiva and cornea.…”

“…All patients responded rapidly to the treatment; the mean score of symptoms reached 31% of their baseline at the end of the 1st week and after 4 weeks, the mean symptom score was 20% of baseline. In another study, Liu et al [23] used 0.1% fluorometholone eye drops and 0.5% cyclosporine eye drops for 35 patients with VKC. They noticed that the dendritic cell density at the conjunctiva decreased significantly (p < 0.05) after 3 months of treatment.…”

Modified lamellar keratoplasty and immunosuppressive therapy guided by in vivo confocal microscopy for perforated Mooren's ulcer

“…Dendritic cells, as antigen presenting cells, are critically involved in autoimmune disease,14 which makes it crucial to have careful control/rational use of topical and systemic immunosuppressive agents after successful surgery. In vivo confocal microscopy (IVCM), a non-invasive, real-time observing approach, can provide dynamic density changes of dendritic cells in vernal keratoconjunctivitis 15. IVCM was used in this study to monitor the density changes of dendritic cells in corneal grafts after modified LK, to guide the usage of corticosteroids and immunosuppressants, and to help reduce the recurrence of malignant Mooren's ulcer.…”