Количественная характеристика клеток Лангерганса в слое нервных волокон роговицы при первичной открытоугольной глаукоме

Abstract

Purpose: To estimate the number of Langerhans cells (LC) in the cornea in primary open-angle glaucoma (POAG) at various stages of the disease. Methods: The study included 129 patients. The main group — 102 patients (204 eyes) aged from 42 to 83 years (62.5±2.4 years) — diagnosed with POAG stage I-IV. The control group consisted of 27 ophthalmologically healthy volunteers (54 eyes) with a normal level of IOP and no signs of POAG aged 54 to 76 years (65.9±1.4 years). The patients underwent visometry, biomicroscopy of the anterior segment of the eye, ophthalmoscopy, gonioscopy, Pascal contour tonometry, optical coherence tomography (OCT) (Zeiss Stratus 3000) and corneal confocal microscopy (CMR) (HRT III, with Rostock Cornea Modul). Results: The average number of LC in patients with glaucoma amounted to 144±21 cells/mm2. It was higher than in the norm group, the difference was statistically significant (p=0.0002). The study revealed an increase in the number of LC associated with the development of glaucoma. A significant positive correlation of the amount of LC in the nerve fiber layer with the stage of the disease (R=0.23, p<0.05) was also found, as well as a negative correlation with the anisotropy coefficient of the directivity of the corneal nerve fibers in the POAG group (R= -0.29, p<0.001). Intereye asymmetry was investigated, which was found to be the higher, the greater the difference in the stages of POAG between paired eyes. With the value of the indicator of interocular asymmetry LC, equal to 19.68%, the sensitivity and specificity of the proposed indicator for the diagnosis of POAG were 94.1 and 66.6%, respectively. Thus, the values of the interocular asymmetry LC indicator above 19.68% are considered pathological. Conclusion: The detected increase in the number of LC in the nerve fiber layer indicates the presence of an inflammatory process in the eye, which may well be autoimmune. And it may be the root cause of open-angle glaucoma, lead to pathological glaucomatous scleropathy with damage to the drainage apparatus of the eye and a corresponding increase in IOP level. It also causes a characteristic clinical course in the form of a chronic, bilateral, low-intensity process. In this sense, the neurodegenerative processes in the anterior and posterior segments of the eye are pathogenetically uniform.