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Tomas Loureiro,1 Sandra Rodrigues-Barros,1 Ana Rita Carreira,1 Filipe Gouveia-Moraes,1 Pedro Carreira,1 Ana Vide Escada,1 Paul Campos,1 Ines Machado,1 Nuno Campos,1 Renato Ambrosio Jr,2 Timothy J Archer,3 Dan Z Reinstein3 1Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal; 2Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; 3London Vision Clinic, London, UKCorrespondence: Tomas Loureiro, Ophthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, Portugal, Tel +351 913 513 175, Email loureiro.tomas@gmail.comPurpose: To evaluate the changes on epithelial thickness before and after topical treatment in primary Sjögren syndrome-associated dry eye disease (SS-DED).Methods: This was a prospective study that included referred women with SS-DED and healthy age-matched controls. Corneal epithelial thickness was evaluated using high-definition anterior segment optical coherence tomography (Cirrus 5000 HD-OCT) in the baseline first consultation, and four weeks after treatment with preservative free 1mg/1mL sodium hyaluronate. Schirmer test 1 (ST1), tear break-up time (TBUT), tear meniscus height (TMH), SICCA Ocular Surface Score (SICCA OSS) and Ocular Surface Disease Index (OSDI) were evaluated. Statistical significance was defined as p-value < 0.05.Results: The study included 40 eyes, 20 with SS-DED and 20 controls. At baseline, SS-DED patients had lower ST1 (11.1 ± 2.2mm vs 14.1 ± 3.1mm, p< 0.01), faster TBUT (9.1 ± 1.8s vs 13.2 ± 1.1s, p< 0.01) and lower TMH (211.2 ± 68.4 μm vs 217.2 ± 60.1μm; p< 0.01) than the control group, whereas SICCA OSS and OSDI were higher (p< 0.01). The superior epithelium was thinner in SS-DED group (41.1 ± 3.2 μm vs 43.1± 2.3 μm, p< 0.01). After treatment, ST1, TBUT, TMH, SICCA OSS, and OSDI improved (p< 0.01), and superior epithelium thickened (p< 0.01) in the SS-DED group.Conclusion: Treatment with sodium hyaluronate improved ST1, TBUT, TMH, SICCA-OSS, and OSDI score. Superior epithelium tends to be thinner in SS-DED but becomes thicker with treatment. Our results seem to illustrate the morphological changes in the corneal epithelium in DED, which could be further recognized as a clinical biomarker of SS-DED.Keywords: dry eye disease, Sjogrenâs syndrome, epithelial thickness, AS-OCT |
