Corneal Langerhans cell and dry eye examinations in ankylosing spondylitis

Abstract

APCs of the ocular surface, including corneal Langerhans cells (LCs), offer the opportunity to gain insight into the activity of innate immunity. We examined corneal LCs and dry eye parameters in ankylosing spondylitis (AS). Twenty-four AS patients with varying degrees of disease activity and 24 healthy participants were enrolled. Central and peripheral LC numbers, and Langerhans cell morphology (LCM) were assessed with in vivo laser confocal microscopy. In addition, ocular surface disease index, lid parallel conjunctival folds, tear break up time, and Schirmer test were evaluated. LC densities and central LCM were greater in AS patients than in the controls. Moreover, LCM was significantly greater in patients with higher systemic inflammation according to elevated C-reactive protein (CRP). Also, tear production was greatly suppressed in patients with more severe onset of the systemic inflammation according to the Bath Ankylosing Spondylitis Disease Activity Index and elevated CRP. Greater corneal LC density and LCM in AS may reflect an increased activation state of the innate immune system of the cornea in AS, which correlates with the systemic activity of AS even without ocular symptoms. Nonetheless, higher systemic inflammation might impair tear production, and it might partly explain the dry eye mechanism.

Corneal Epithelial Immune Dendritic Cell Alterations in Subtypes of Dry Eye Disease: A Pilot In Vivo Confocal Microscopic Study

“…15,16,27,33,34 Evaluation of DC in the clinical setting has recently been facilitated by the fact that they can be easily detected and quantified by laser IVCM, 16,26,35,36 with high interobserver agreement in their quantification (R ¼ 0.997; P < 0.001). 37 Using IVCM, although our control group had a DC density within the range reported before, the DED group showed a significantly higher DC density in the central cornea, as has been reported before, [18][19][20][21] with an average increase of 700% compared with the age-matched controls. Furthermore, using a detailed morphologic description of DCs, we demonstrated that in DED these immune cells had a larger cell size with increased number and length of dendrites.…”

“…6,7 Given their established role in immune regulation of the ocular surface, [5][6][7] there has been a recent interest in evaluation of their alterations in various ocular surface diseases. Recent studies have shown that the DC density significantly increases in various conditions such as DED, [17][18][19][20][21]29 corneal graft rejection, 5,30 contact lens wear, 22,31 and infectious keratitis. 32 In addition to changes in DC density, the morphology of these cells changes upon stimulation, resulting in maturation of these cells with an increase in cell size and formation and lengthening of dendritic processes.…”

“…15,16 Using IVCM in patients with DED, recent studies have shown changes in DCs in the corneal subbasal layer. [17][18][19][20][21] However, the extent of DC changes remain unclear in different subtypes of DED.…”

Corneal confocal microscopy: ready for prime time

“…Two recent studies have shown a difference in cell infiltration rates in Sjögren's compared to non‐Sjögren's dry eyes, while activity of innate immunity in ankylosing spondylitis and rheumatoid arthritis has also been associated with Langerhans cells density and morphology.…”

Improvement of conjunctival cytological grade and tear production in Ankylosing Spondylitis patients under TNF inhibitors: a long-term follow-up

“…However, keratoconjunctivitis sicca (KCS), generally known as dry eye disease (DED), could also occur [2][3][4] . There are few and inconsistent reports regarding the simultaneous occurrence of AS and DED, even though the eye dry eye tests performed in these studies were incomplete [5][6][7] .…”