Corneal involvement in Crohn's disease: an in vivo confocal microscopy study.
OBJECTIVE
To evaluate the corneal changes of patients with Crohn's disease (CD) using confocal microscopy and to investigate the association among confocal parameters and CD activity and CD treatment.


METHODS
Thirty consecutive patients (age: 42 ± 12 years; 19 women and 11 men) affected by CD and 30 control eyes (age matched and gender matched) underwent an ophthalmic examination and, in 1 eye chosen at random, confocal microscopy of the central cornea using the cornea module of Heidelberg Retina Tomograph. The following confocal parameters were evaluated: density of basal epithelial cells, epithelial dendritic cells, anterior and posterior stromal keratocytes, and endothelial cells; the subbasal plexus was assessed for number and tortuosity of the nerve fibers.


RESULTS
Routine ophthalmic evaluation was normal in the whole population. At confocal microscopy, 40% of patients with CD had hyperreflective dots in the basal epithelium, which were absent in the control group. Activation of keratocytes was found in 86.6% of patients with CD and was absent in the control group. Compared with controls, patients with CD had lower density of dendritic cells (12.2 ± 26.3 vs. 50.3 ± 37.6 cells per square millimeter; P = 0.001). The other confocal parameters were similar in the 2 groups. No correlation between CD activity index and confocal changes was found.


CONCLUSIONS
Confocal microscopy can detect subtle corneal changes in patients with CD, which may be signs of subclinical inflammation.
Ceresara
Gaia
G
Cinica Oculistica, Dipartimento di Medicina, Chirurgia e Odontoiatria, Ospedale San Paolo, Milano, Italy. gaia.ceresara@gmail.com
Fogagnolo
Paolo
P
De Cillà
Stefano
S
Panizzo
Valerio
V
Danelli
Pier Giorgio
PG
Orzalesi
Nicola
N
Rossetti
Luca
L
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003315:Cornea / Q000473:pathology*; D003319:Corneal Stroma / Q000473:pathology; D003424:Crohn Disease / Q000188:drug therapy / Q000473:pathology*; D003430:Cross-Sectional Studies; D003713:Dendritic Cells / Q000473:pathology; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D018613:Microscopy, Confocal; D008875:Middle Aged; D015203:Reproducibility of Results
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine