Central Corneal Subbasal Nerve Plexus Abnormalities in Sjögren Disease: A Pilot Study

Area of Science:

• Ophthalmology
• Neurology
• Rheumatology

Background:

• Small-fiber neuropathy (SFN) is a recognized complication of Sjögren disease (SjD).
• In vivo corneal confocal microscopy (IVCM) is a non-invasive technique capable of visualizing corneal nerve structures.
• IVCM can detect morphological changes consistent with SFN in the corneal subbasal nerve plexus.

Purpose of the Study:

• To describe features of SFN in the corneal subbasal nerve plexus of individuals with Sjögren disease.
• To utilize in vivo confocal microscopy to identify and quantify nerve metrics in the cornea.
• To assess the potential of corneal nerve abnormalities as a biomarker for Sjögren disease.

Main Methods:

• A descriptive study involving 11 participants with Sjögren disease and 22 healthy controls.
• In vivo confocal microscopy was performed on the central corneal subbasal nerve plexus.
• Automated software (ACCmetrics) analyzed 30-image montages to quantify 7 nerve metrics.

Main Results:

• Participants with Sjögren disease exhibited significantly lower corneal nerve metrics compared to healthy controls.
• Mean corneal nerve fiber density was 3.5 mm/mm² in SjD patients versus 10.6 mm/mm² in controls (P=0.02).
• A central whorl, a landmark for analysis, was identifiable in fewer SjD eyes (27%) than in healthy controls (95%).

Conclusions:

• Sjögren disease is associated with reduced corneal nerve metrics.
• These findings suggest that IVCM-detected corneal nerve abnormalities are compatible with SFN and can differentiate SjD patients from healthy individuals.
• Corneal nerve metrics may represent a novel biomarker for the identification of Sjögren disease.