Central Corneal Subbasal Nerve Plexus Abnormalities in Sjögren Disease: A Pilot Study - PubMed (original) (raw)

Central Corneal Subbasal Nerve Plexus Abnormalities in Sjögren Disease: A Pilot Study

Jeremy Nortey et al. Cornea. 2023.

Abstract

Purpose: Small-fiber neuropathy (SFN) is known to be associated with Sjögren disease (SjD), and in vivo corneal confocal microscopy can identify features compatible with SFN. Here, we performed a descriptive study to identify features of SFN of the corneal subbasal nerve plexus using in vivo confocal microscopy.

Methods: We recruited 10 participants from the Sjögren's International Collaborative Clinical Alliance (SICCA), 1 new participant (in an effort to expand the SICCA cohort), and 22 healthy controls. All participants underwent slit-lamp examination and in vivo confocal microscopy of the central corneal subbasal nerve plexus centered about the central whorl to create a 30-image montage. Each image was analyzed with automated software (ACCmetrics, Manchester, United Kingdom) to produce 7 nerve metrics. We performed t-tests and age-adjusted regressions to make comparisons of nerve metrics between participants with SjD and healthy controls.

Results: Most nerve metrics were significantly lower in participants with SjD compared with healthy controls. The mean corneal nerve fiber density was found to be 3.5 mm/mm 2 in participants with SjD compared with 10.6 mm/mm 2 in healthy controls (95% confidence interval, -8.4 to -0.93; P = 0.02). Within the 11 participants with SjD, 22 eyes were analyzed on confocal microscopy, and 16 of those eyes (from 9 individuals) did not have an identifiable central whorl. Within the 22 healthy controls, 22 eyes (right eye alone) were analyzed on confocal microscopy, and 21 of those eyes had an identifiable central whorl.

Conclusions: SjD exhibits lower corneal nerve metrics compared with healthy controls. These findings suggest that features compatible with SFN can distinguish SjD from healthy controls and may serve as a potential novel biomarker in identifying SjD.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

Figure 1:

Figure 1:

30-image montage from a healthy control participant of the cornea’s sub-basal nerve plexus within the right eye using in vivo confocal microscopy.

Figure 2:

Figure 2:

(A) Bar graphs of average nerve metrics by Sjögren’s Disease classification for CNFD, CNBD, CNFL, CTBD and CNFracDim. (B) Bar graphs of average nerve metrics by Sjogren’s Disease classification for CNFA and CNFW.

Figure 2:

Figure 2:

(A) Bar graphs of average nerve metrics by Sjögren’s Disease classification for CNFD, CNBD, CNFL, CTBD and CNFracDim. (B) Bar graphs of average nerve metrics by Sjogren’s Disease classification for CNFA and CNFW.

Figure 3:

Figure 3:

Examples of neuromas found in SjD participant montages.

Figure 4:

Figure 4:

Examples of dendritic cells found in SjD participant montages.

Figure 5:

Figure 5:

Examples of increased nerve tortuosity found in SjD participant montages.

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