title: An essential role for dendritic cells in vernal keratoconjunctivitis: analysis by laser scanning confocal microscopy.
abstract: BACKGROUND
  CD4+ T helper type 2 cells play a central role in the pathogenesis of vernal keratoconjunctivitis (VKC), and antigen-presenting cells are required for the cell activation. In this study, we aimed to survey the density, distribution, and morphology of dendritic cells (DCs) in patients with VKC by in vivo confocal microscopy.
  
  
  METHODS
  Thirty-five patients (mean, 12.4 ± 5.3 years) affected by VKC were included. All patients were treated with 0.1% fluorometholone eye drops and 0.5% cyclosporine A eye drops. The density and morphological and distributional characteristics of DCs in each right eye were evaluated by in vivo confocal microscopy before treatment and at 1, 3, and 6 months after treatment. Thirty-five age-matched normal subjects (mean, 16.5 ± 1.8 years) were studied as controls.
  
  
  RESULTS
  There was significant difference in age between the VKC group and the control group (F = 18.17, P < 0.05). Compared with normal eyes, increased numbers of DCs were found in patients with VKC, with mean cell densities of 244.09 ± 59.76 cells/mm(2) at the bulbar conjunctiva, 574.53 ± 87.34 cells/mm(2) at the limbus, and 403.32 ± 106.59 cells/mm(2) at the peripheral cornea before treatment. These DCs exhibited a typical dendritic shape. At 3 months after treatment, the DC density at the conjunctiva decreased significantly (P < 0.05), approximating that in the controls. At 3 and 6 months, the DC densities at the limbus and peripheral cornea also decreased significantly (P < 0.05), but were still statistically higher than those in the controls. These DCs, with small dendritic processes or irregular shapes, were observed to gradually locate at the epithelial basal membrane and subbasal nerve plexus.
  
  
  CONCLUSIONS
  In vivo confocal microscopy appears to be a valuable tool in evaluating the dynamic change of DCs at the conjunctiva and cornea. DCs play an essential role in VKC and therefore may constitute a target for therapeutic intervention for VKC.
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.
authors.forename: M
authors.initials: M
authors.lastname: Liu
authors.forename: H
authors.initials: H
authors.lastname: Gao
authors.forename: T
authors.initials: T
authors.lastname: Wang
authors.forename: S
authors.initials: S
authors.lastname: Wang
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.forename: W
authors.initials: W
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D002648:Child; D003228:Conjunctiva / Q000276:immunology / Q000473:pathology; D003233:Conjunctivitis, Allergic / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*; D003315:Cornea / Q000276:immunology / Q000473:pathology; D003713:Dendritic Cells / Q000276:immunology* / Q000473:pathology*; D005260:Female; D006801:Humans; D016850:Limbus Corneae / Q000276:immunology / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal; D055815:Young Adult
keywords: dendritic cells; laser scanning microscopy; vernal keratoconjunctivitis