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Corneal Changes in Acanthamoeba Keratitis at Various Levels of Severity: An In Vivo Confocal Microscopic Study
Zhenyu Wei1, Kai Cao1, Leying Wang1
1Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.
Purpose:
To investigate the relationship between Acanthamoeba cysts and inflammatory cells in Acanthamoeba keratitis (AK) by in vivo confocal microscopy (IVCM).
Methods:
A case-control study included 30 patients with AK and 20 normal controls. The severity of the AK was divided into mild, moderate, and severe. The central cornea and four standard quadrants of the peripheral cornea were imaged by IVCM. The cyst infiltration and dendritic cell (DC) density and maturity (size, length, field, and number of dendrites) were quantified. The relationship between clinical severity, cyst density, and DC alterations was characterized by Spearman correlation analysis.
Results:
The maximum cyst density in the mild, moderate, and severe groups was 31.3 cysts/mm2 (17.2-32.8), 62.5 cysts/mm2 (59.3-103.1), and 162.5 cysts/mm2 (65.6-215.6), respectively. Compared to normal participants, a significant increase in the mean corneal DC density was detected in patients with AK (290.2 ± 97.0 vs. 25.3 ± 8.3 cells/mm2; P < 0.001). Patients with AK presented an increase in median DC size (178.3 vs. 63.6 µm2/cell, P < 0.001), median DC field (518.1 vs. 256.6 µm2/cell, P = 0.008), and median DC dendrite length (42.3 vs. 14.7 µm/cell, P < 0.001). Increased AK severity was correlated with an increase in cyst density, DC size, and dendrite length (all P < 0.05). An increase in cyst density was significantly correlated with an increase in DC density (β = 0.484, P = 0.026) and DC size (β = 0.557, P = 0.009).
Conclusions:
Cyst density and depth of infiltration as well as maturity of the surrounding DC increased significantly with the severity of AK.
Translational Relevance:
Quantitative analysis of cyst density and DC maturity may provide a new method of evaluating the severity of AK.
Insights
Acanthamoeba keratitis (AK) severity correlates with increased Acanthamoeba cyst density and inflammatory dendritic cell (DC) changes. Quantitative analysis of cysts and DCs may offer a new way to assess AK severity.
Area of Science:
- Ophthalmology
- Microbiology
- Immunology
Background:
- Acanthamoeba keratitis (AK) is a severe microbial keratitis caused by Acanthamoeba species.
- Inflammatory responses, particularly involving dendritic cells (DCs), play a crucial role in the pathogenesis of AK.
- Understanding the interplay between Acanthamoeba cysts and corneal immune cells is vital for effective management.
Purpose of the Study:
- To investigate the relationship between Acanthamoeba cysts and inflammatory cells, specifically dendritic cells (DCs), in patients with Acanthamoeba keratitis (AK).
- To quantify cyst infiltration and DC characteristics using in vivo confocal microscopy (IVCM).
- To correlate these findings with the clinical severity of AK.
Main Methods:
- A case-control study involving 30 AK patients and 20 healthy controls.
- In vivo confocal microscopy (IVCM) was used to image the central and peripheral cornea.
- Quantification of Acanthamoeba cyst density and DC density, size, field, and dendrite length.
- Spearman correlation analysis was employed to assess relationships between clinical severity, cyst density, and DC alterations.
Main Results:
- Acanthamoeba cyst density significantly increased with AK severity (mild, moderate, severe).
- Corneal DC density, size, field, and dendrite length were significantly higher in AK patients compared to controls.
- Increased AK severity correlated with higher cyst density, DC size, and dendrite length.
- Higher cyst density was significantly associated with increased DC density and size.
Conclusions:
- Cyst density and the maturity of surrounding dendritic cells (DCs) increase significantly with the severity of Acanthamoeba keratitis (AK).
- Quantitative analysis of cyst density and DC maturity shows promise as a novel method for evaluating AK severity.
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