Corneal confocal scanning laser microscopy in patients with dry eye disease treated with topical cyclosporine

Purpose To investigate the effect of cyclosporine on corneal ultrastructure and on major signs and symptoms of patients with dry eye disease.Patients and methods In this prospective cohort study, patients with dry eye disease were treated with a drop of cyclosporine 0.05% twice daily. Clinical evaluation was carried out at baseline and at months 1, 3, and 6. All patients completed the Ocular Surface Disease Index (OSDI) questionnaire, and tear film break-up time (BUT), fluorescein and lissamine green staining, and Schirmer test were carried out. In vivo confocal microscopy was also performed and epithelial cellular density, keratocyte activation, and subbasal plexus morphology were assessed.Results A total of 40 patients completed the study. After 6 months, OSDI, BUT, and fluorescein and lissamine green staining showed a clinically significant improvement. During the 6-month follow-up, density of intermediate epithelial cells increased from 1969.5 +/- 85.4 cell/mm(2) to 4881.2 +/- 75.7 cell/mm(2) (P<0.01); average grade of keratocyte activation decreased from 3.6 +/- 0.1 to 1.8 +/- 0.1 (P<0.001); average grade of number of subbasal nerves decreased from 5.3 +/- 0.2 to 2.6 +/- 0.2 (P<0.001); average grade of nerve reflectivity decreased from 3.8 +/- 0.1 to 2.1 +/- 0.2 (P<0.001); and average grade of nerve tortuosity decreased from 3.8 +/- 0.1 to 2.2 +/- 0.2 (P<0.001).Conclusion Cyclosporine was effective in controlling symptoms and signs of dry eye disease. In vivo confocal microscopy showed an increase in cell density of intermediate epithelium cells, a decrease in hyper-reflective keratocytes, and a decrease in density, tortuosity, and reflectivity of nerve fibers.