Evaluation of conjunctival inflammatory status by confocal scanning laser microscopy and conjunctival brush cytology in patients with atopic keratoconjunctivitis (AKC).
OBJECTIVE
To elucidate the status of the conjunctival inflammation in atopic keratoconjunctivitis (AKC) using laser scanning confocal microscopy and compare the relevant findings with conjunctival brush cytology in a prospective controlled study.


METHODS
Twenty eyes from 20 AKC patients as well as 16 eyes from 16 age and sex matched normal subjects were studied. The subjects underwent tear film break-up time (BUT), fluorescein and Rose Bengal staining of the ocular surface, conjunctival confocal microscopy, Schirmer test, and brush cytology. Brush cytology specimens and in vivo confocal microscopy scans underwent evaluation for inflammatory cell densities.


RESULTS
Brush cytology specimens and in vivo confocal microscopy scans from AKC patients revealed significantly higher numbers of inflammatory cells (p<0.05). Conjunctival inflammatory cell density showed a negative correlation with tear stability and a positive correlation with vital staining scores and conjunctival injection grades. The extent of conjunctival inflammation assessed by in vivo confocal microscopy showed a strong positive linear correlation with the inflammation status evaluated by brush cytology. The corneal inflammatory cell density assessed by in vivo confocal microscopy showed a significant negative correlation with tear stability and a positive linear correlation with corneal fluorescein staining.


CONCLUSIONS
Confocal scanning laser microscopy is an efficient, noninvasive, and a promising tool for the quantitative assessment of conjunctival inflammation, a parameter of this new technology which correlated well with subjective and objective ocular surface clinical findings.
Wakamatsu
Tais Hitomi
TH
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Okada
Naoko
N
Kojima
Takashi
T
Matsumoto
Yukihiro
Y
Ibrahim
Osama M A
OM
Dogru
Murat
M
Adan
Enrique Sato
ES
Fukagawa
Kazumi
K
Katakami
Chikako
C
Tsubota
Kazuo
K
Shimazaki
Jun
J
Fujishima
Hiroshi
H
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002452:Cell Count; D002648:Child; D003584:Cytological Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology* / Q000503:physiopathology; D007267:Injections; D007637:Keratoconjunctivitis / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D013194:Staining and Labeling; D013499:Surface Properties; D013666:Tears / Q000378:metabolism
Ophthalmologica. 1999;213(1):16-9
9838252
Ophthalmology. 2006 Dec;113(12):2203-8
17157133
Eur J Ophthalmol. 2003 Aug-Sep;13(7):606-10
14552593
Br J Dermatol. 2001 Mar;144(3):523-32
11260009
Ophthalmology. 2004 Feb;111(2):396-406
15019397
Cornea. 2005 Nov;24(8):985-8
16227847
Mol Vis. 2007 Aug 30;13:1562-7
17893656
Allergy. 2007 Aug;62(8):917-25
17620070
Mol Vis. 2008 Jul 09;14:1263-71
18618006
Ophthalmology. 1998 Aug;105(8):1478-84
9709761
Clin Exp Allergy. 2006 Dec;36(12):1556-65
17177679
Klin Monbl Augenheilkd. 2005 Nov;222(11):894-900
16308822
Clin Exp Allergy. 2007 Apr;37(4):526-35
17430349
Exp Eye Res. 2004 Mar;78(3):473-81
15106926
Eye (Lond). 2007 Feb;21(2):271-2
16858439
Cornea. 2001 Oct;20(7):743-7
11588428
Cornea. 1993 Jul;12(4):366-7
7687944
Mol Vis. 2007 Jul 25;13:1319-26
17679934
Cornea. 2004 Jul;23(5):464-7
15220730
Curr Eye Res. 2003 Jun;26(6):319-25
12868012
Ophthalmology. 2004 Mar;111(3):476-82
15019322
J Immunol. 1990 Oct 15;145(8):2626-32
2170521
J Fr Ophtalmol. 2005 Sep;28(7):691-8
16208218
Mol Vis. 2007 Aug 10;13:1379-89
17768384
Mol Vis. 2006 Nov 16;12:1392-402
17149365
Curr Eye Res. 2004 Oct-Nov;29(4-5):235-43
15590468
Eye (Lond). 1993;7 ( Pt 3 Suppl ):21-5
8253220
Br J Ophthalmol. 2004 Dec;88(12):1504-5
15548799