title: In vivo confocal microscopic characterisation of the cornea in chronic graft-versus-host disease related severe dry eye disease.
abstract: OBJECTIVE
  To first describe in vivo confocal microscopic (IVCM) corneal findings in severe dry eye syndrome due to ocular chronic graft versus host disease (cGvHD) after allogeneic stem cell transplantation.
  
  
  METHODS
  IVCM of the central cornea was performed in 12 prospectively recruited patients with severe ocular cGvHD associated dry eye syndrome and in six control patients with haematological malignancies without cGvHD. Within each examined corneal layer, at least three non-overlapping areas were selected for representative analysis.
  
  
  RESULTS
  The number of sub basal nerve branches was markedly reduced in patients with cGvHD. Sub basal nerve morphology was characterised by increased tortuosity and reduced reflectivity. Accumulation of hyper-reflective extracellular matrix, significantly increased haze and increased keratocyte density were found in the anterior stroma of the study group.
  
  
  CONCLUSIONS
  IVCM findings of the cornea in patients with severe ocular cGvHD include a rarefaction of the sub basal corneal nerve plexus and dense accumulation of hyper-reflective extracellular matrix in the anterior stroma.
authors.affiliation: Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Steger
authors.affiliation: Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Speicher
authors.affiliation: Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Philipp
authors.affiliation: Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: N E
authors.initials: NE
authors.lastname: Bechrakis
mesh_terms: D000328:Adult; D000368:Aged; D002452:Cell Count; D002908:Chronic Disease; D003228:Conjunctiva / Q000378:metabolism; D003315:Cornea / Q000294:innervation*; D060527:Corneal Keratocytes / Q000473:pathology; D003319:Corneal Stroma / Q000473:pathology; D003389:Cranial Nerve Diseases / Q000175:diagnosis*; D003713:Dendritic Cells / Q000473:pathology; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000209:etiology; D004728:Endothelium, Corneal / Q000473:pathology; D019573:Epithelium, Corneal / Q000473:pathology; D005109:Extracellular Matrix / Q000473:pathology; D005260:Female; D019793:Fluorescein / Q000378:metabolism; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008086:Lissamine Green Dyes / Q000378:metabolism; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009882:Ophthalmic Nerve / Q000473:pathology*; D011446:Prospective Studies; D033581:Stem Cell Transplantation; D013666:Tears / Q000502:physiology; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D008086:Lissamine Green Dyes; D019793:Fluorescein
keywords: Cornea; Immunology; Inflammation