In vivo confocal microscopy morphometric analysis of corneal subbasal nerve plexus in dry eye disease using newly developed fully automated system

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 257; no. 3; pp. 583 - 589
• Main Authors: Giannaccare, Giuseppe, Pellegrini, Marco, Sebastiani, Stefano, Moscardelli, Fabiana, Versura, Piera, Campos, Emilio C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2019; Springer Nature B.V
• Subjects: Automation; Computer programs; Confocal microscopy; Cornea; Eye diseases; Medicine; Medicine & Public Health; Microscopy; Morphometry; Ophthalmology; Retina; Automated analysis; Sub-basal nerve plexus; ACCMetrics; Dry eye; In vivo confocal microscopy
• ISSN: 0721-832X; 1435-702X; 1435-702X
• DOI: 10.1007/s00417-018-04225-7

Purpose To evaluate in vivo confocal microscopy (IVCM) features of corneal subbasal nerve plexus (SNP) in the setting of dry eye disease (DED) using fully automated software “ACCMetrics,” and to further investigate its diagnostic performance in discriminating DED patients. Methods IVCM exams of SNP in DED patients and matched control subjects were performed using Heidelberg Retina Tomograph with the Rostock Cornea Module. The following parameters were obtained with ACCMetrics: corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal nerve total branch density (CTBD), corneal nerve fiber area (CNFA), corneal nerve fiber width (CNFW), and corneal nerve fractal dimension (CNFrD). The Mann–Whitney U test was used to compare variables. Receiver operating characteristic curves with calculations of the area under the curve (AUC) were used to describe the accuracy of IVCM parameters for discriminating DED patients from controls. Results Thirty-nine DED patients and 30 control subjects were included. Significantly, lower values of CNFD, CNBD, and CNFL and higher value of CNFW were found in DED patients compared to controls (respectively, 20.5 ± 8.7 vs 25.4 ± 6.7 n/mm 2 ; 25.6 ± 20.1 vs 37.6 ± 21.5 n/mm 2 ; 12.6 ± 4.4 vs 14.5 ± 2.9 mm/mm 2 ; 0.021 ± 0.001 vs 0.019 ± 0.001 mm/mm 2 ; always p  < 0.024). CNFW value had the highest diagnostic power in discriminating DED patients (AUC = 0.828). When the diagnosis of DED was made based on either CNFW or CNBD, the sensitivity was 97.4% and the specificity 46.7%. Conclusions The software ACCMetrics was able to rapidly detect SNP alterations occurring in the setting of DED and showed good diagnostic performance in discriminating DED patients.