Abstract
PurposeLess was known about globular cells which were a type of dendritic cells (DCs) in cornea. We aimed to investigate the morphological and distribution characteristics of globular cells in corneal vortex and their clinical correlations with ocular surface.MethodsCase records of patients who underwent in vivo confocal microscopy (IVCM) were evaluated retrospectively. The morphology and distribution features of globular cells in cornea nerve vortex and their co-existence status with Langerhans cells (LCs) were analyzed. Data of ocular surface symptoms and signs were collected and their correlations with globular cells distribution patterns and dendritic forms were performed. Dry eye patients without LCs were treated with preservative-free artificial tears, while patients with LCs were treated with artificial tears and fluoromethalone until the activated LCs disappeared.ResultsA total of 836 eyes from 451 individuals were included. Three distribution patterns of globular cells in vortex were investigated, type 1 scattered globular cells (57.66%), type 2 large amounts of globular cells (≥50 cells) gathering in vortex and along some fixed vortex direction horizontally (13.52%) and type 3 no globular cells (28.83%). Their location and cell count altered slightly in the follow-ups but would not disappear. LCs could co-exist with globular cells and could fade after treatment. The type 2 distribution pattern was associated with older age (p = 0.000) and higher upper eyelid Meiboscore (p = 0.006). Dendritic globular cells had higher Meiboscore than Non-dendritic forms.ConclusionsGlobular cells had characteristic distribution patterns and biological features different from LCs. They were associated with long-term irritation of the meibomian gland dysfunction.
Highlights
With the help of in vivo confocal microscopy (IVCM), much has been learned about the microscopic environment of the cornea, nerves and cells under both physiological and pathological conditions, and new findings constantly come up [1,2,3,4]
Including follow-ups, ∼1262 IVCM records with good-quality images of the corneal nerve vortex were analyzed
The cornea is susceptible to various inflammatory diseases mediated by immunity, such as infections and autoimmunity, which are attributed to resident myeloid cell populations, such as epithelial Langerhans cells (LCs) and stromal macrophages and dendritic cells (DCs), which can function as antigen-presenting cells (APCs) [23, 24]
Summary
A type of large, bright, oval-shaped cells at the sub-epithelial nerve plexus came into our sight recently. In addition to their different body shapes from other resident cells, they had unique distribution patterns, mainly gathering in vortices and spreading along nerves in a fixed horizontal. We noticed their existence in some previous studies of IVCM but the authors either did not mention this special cells or mistook them for Langerhans cells (LCs) [5,6,7]. Mastropasqua L and colleagues named them globular cells in 2006 and this name was followed by other authors [8, 9]. No further information about their clinical characteristic were analyzed
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