Patients with multiple sclerosis demonstrate reduced subbasal corneal nerve fibre density.
BACKGROUND
Many studies in multiple sclerosis (MS) have investigated the retina. Little, however, is known about the effect of MS on the cornea, which is innervated by the trigeminal nerve. It is the site of neural-immune interaction with local dendritic cells reacting in response to environmental stimuli.


OBJECTIVE
This study aims to investigate the effect of MS on corneal nerve fibres and dendritic cells in the subbasal nerve plexus using in vivo confocal microscopy (IVCM).


METHODS
We measured the corneal nerve fibre and dendritic cell density in 26 MS patients and matched healthy controls using a Heidelberg Retina Tomograph with cornea module. Disease severity was assessed with the Multiple Sclerosis Functional Composite, Expanded Disability Status Scale, visual acuity and retinal optical coherence tomography.


RESULTS
We observed significant reduction in total corneal nerve fibre density in MS patients compared to controls. Dendritic cell density was similar in both groups. Reduced total nerve fibre density was associated with worse clinical severity but not with previous clinical trigeminal symptoms, retinal neuro-axonal damage, visual acuity or disease duration.


CONCLUSIONS
Corneal nerve fibre density is a promising new imaging marker for the assessment of disease severity in MS and should be investigated further.
NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Janine
J
Mikolajczak
NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Hanna
H
Zimmermann
Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Ahmad
A
Kheirkhah
NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Ella Maria
EM
Kadas
NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Timm
T
Oberwahrenbrock
Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Rodrigo
R
Muller
Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Aiai
A
Ren
NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Joseph
J
Kuchling
Department of Optometry, Beuth University of Applied Sciences, Berlin, Germany.
Holger
H
Dietze
Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany/German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.
Harald
H
Prüss
NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany/Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.
Friedemann
F
Paul
Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA/Boston Image Reading Center and Cornea Service, New England Eye Center, Boston, MA, USA/Tufts Medical Center, Department of Ophthalmology, School of Medicine, Tufts University, Boston, MA, USA.
Pedram
P
Hamrah
NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Alexander U
AU
Brandt
D000328:Adult; D015415:Biomarkers; D002452:Cell Count; D003315:Cornea / Q000000981:diagnostic imaging* / Q000294:innervation*; D003712:Dendrites / Q000648:ultrastructure*; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009412:Nerve Fibers / Q000648:ultrastructure*; D012720:Severity of Illness Index; D014276:Trigeminal Nerve / Q000000981:diagnostic imaging*; D055815:Young Adult
D015415:Biomarkers
Multiple sclerosis; cornea; peripheral nerves; retina; subbasal nerve plexus; trigeminal neuralgia