[Assessment of Langerhans Cells in the Central Cornea as Tool for Monitoring Inflammatory Changes in Patients with Keratoconjunctivitis sicca under Topical Therapy with Cyclosporine A 0.05% Eye Drops].

BACKGROUND: Keratoconjunctivitis sicca is one of the most common ocular diseases and is associated with a considerable decrease in the quality of life. It is accompanied by symptoms of discomfort, tear film instability, hyperosmolarity of the tear film, inflammation of the ocular surface and neurosensory abnormalities. It is still not clear yet if the density of Langerhans cells in the central cornea can be used for objective evaluation of the inflammation in the tear film and the ocular surface.

PATIENTS AND METHODS: 47 patients (age 21 - 85 years, 13 male and 34 female patients) with moderate to severe keratoconjunctivitis sicca (according to the DEWS criteria severity level 2 - 3) were enrolled in this prospective, clinical trial. Patients were treated for 3 months with topical anti-inflammatory therapy with cyclosporine 0,05% eye drops twice daily. The following parameters were examined: OSDI Score, tear break-up time (TBUT), Schirmer test with anaesthesia, lid-parallel conjunctival folds (LIPCOF), in-vivo confocal microscopy with HRT II and RCM for evaluation of Langerhans cell density in the central cornea, visual acuity, tear film osmolarity and Meibomian gland dysfunction (MGD).

RESULTS: After anti-inflammatory treatment, there was a significant reduction in the density of Langerhans cells (p ≤ 0.001**), an increase in TBUT (p ≤ 0.001**), as well as a significant decrease in tear film osmolarity (p ≤ 0.05*) and OSDI Score (p ≤ 0 001**). Visual acuity, MGD and Schirmer test did not change significantly.

CONCLUSIONS: The results of this clinical trial show that topical anti-inflammatory therapy with cyclosporine A 0.05% eye drops in patients with moderate to severe keratoconjunctivitis sicca is effective in reducing inflammation of the ocular surface and the tear film, as well as in increasing the quality of life in these patients. Evaluation of Langerhans cell density in the central corneal epithelium by in vivo confocal microscopy is an effective objective diagnostic feature in monitoring anti-inflammatory therapy in patients with dry eye disease or other ocular surface pathologies.