title: Increased corneal sub-basal nerve density in patients with Sjögren syndrome treated with topical cyclosporine A.
abstract: BACKGROUND
  To evaluate quantitative and qualitative changes in sub-basal corneal nerves (SBN) via in vivo confocal microscopy in patients with Sjögren syndrome dry eye (SSDE) treated with topical cyclosporine A (CsA).
  
  
  METHODS
  Prospective, observational, non-randomized study.
  
  
  METHODS
  Thirty eyes of 30 patients with SSDE refractory to conventional treatment treated with CsA 0.05% twice daily for 6 months. Fifteen eyes of 15 healthy, age and gender matched, volunteers constituted the control group at baseline.
  
  
  METHODS
  A clinical evaluation of dry eye, corneal sensation using Cochet-Bonnet esthesiometry and in vivo confocal microscopy analysis of the central cornea were performed prospectively at baseline for all patients, and after 6 months of treatment with CsA.
  
  
  METHODS
  Density, number, reflectivity and tortuosity of SBN, dendritic cell (DC) density, esthesiometry, and dry eye signs and symptoms.
  
  
  RESULTS
  Topical CsA 0.05% improved clinical signs and symptoms, and increased corneal sensitivity. Following treatment, SBN density was significantly increased (P < 0.0001) associated with a decreased in DC density (P < 0.0001). The increase in SBN density after treatment was positively correlated with baseline SBN density (R2= 0.33; P = 0.0008) and negatively correlated with baseline Ocular Surface Disease Index (R2= 0.28; P = 0.002), Oxford score (R2= 0.31; P = 0.002), and DC density (R2= 0.37; P = 0.0003).
  
  
  CONCLUSIONS
  Topical CsA led to an increase in corneal SBN density, improving clinical signs and symptoms of SSDE. Our results also suggest an improved response to treatment in patients with less initial nerve damage.
authors.affiliation: Department V, Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France.|Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DHOS CIC, Paris, France.
authors.forename: Ora
authors.initials: O
authors.lastname: Levy
authors.affiliation: Department III, Quinze-Vingts National Ophthalmology Hospital, Versailles-Saint-Quentin en Yvelines University, Paris, France.|Sorbonne Universities, UPMC Univ Paris 06, UMR S 968, Vision Institute, Paris, France.|CNRS, UMR 7210, Paris, France.|Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DHOS CIC, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Labbé
authors.affiliation: Department V, Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France.|Sorbonne Universities, UPMC Univ Paris 06, UMR S 968, Vision Institute, Paris, France.|CNRS, UMR 7210, Paris, France.|Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DHOS CIC, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Borderie
authors.affiliation: Department V, Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France.|Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DHOS CIC, Paris, France.
authors.forename: Taous
authors.initials: T
authors.lastname: Hamiche
authors.affiliation: Department III, Quinze-Vingts National Ophthalmology Hospital, Versailles-Saint-Quentin en Yvelines University, Paris, France.|Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DHOS CIC, Paris, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Dupas
authors.affiliation: Department V, Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France.|Sorbonne Universities, UPMC Univ Paris 06, UMR S 968, Vision Institute, Paris, France.|CNRS, UMR 7210, Paris, France.|Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DHOS CIC, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Laroche
authors.affiliation: Department III, Quinze-Vingts National Ophthalmology Hospital, Versailles-Saint-Quentin en Yvelines University, Paris, France.|Sorbonne Universities, UPMC Univ Paris 06, UMR S 968, Vision Institute, Paris, France.|CNRS, UMR 7210, Paris, France.|Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DHOS CIC, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Baudouin
authors.affiliation: Department V, Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Universities, Paris, France.|Sorbonne Universities, UPMC Univ Paris 06, UMR S 968, Vision Institute, Paris, France.|CNRS, UMR 7210, Paris, France.|Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DHOS CIC, Paris, France.
authors.forename: Nacim
authors.initials: N
authors.lastname: Bouheraoua
mesh_terms: D000287:Administration, Topical; D002452:Cell Count; D003315:Cornea / Q000294:innervation*; D016572:Cyclosporine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D018613:Microscopy, Confocal; D009412:Nerve Fibers / Q000473:pathology*; D009882:Ophthalmic Nerve / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D012677:Sensation / Q000187:drug effects*; D012859:Sjogren's Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: cornea; corneal innervation; corneal nerve; cyclosporine; dry eye