Goblet Cell Numbers and Epithelial Proliferation in the Conjunctiva of Patients With Dry Eye Syndrome Treated With Cyclosporine
Kathleen S. Kunert;
Ann S. Tisdale;
Ilene K. Gipson
Arch Ophthalmol. 2002;120:330-337.
Objectives To compare conjunctival goblet cell numbers as well as epithelial turnover
in patients with non–Sjögren syndrome–associated keratoconjunctivitis
sicca (NSS-KCS) and those with SS-KCS before and after 6 months of treatment
with topical cyclosporine A (CsA) ophthalmic emulsion.
Methods Conjunctival biopsy specimens from 16 patients with NSS-KCS and 12 with
SS-KCS were obtained at baseline and after 6 months' therapy with CsA or vehicle
alone. Conjunctival biopsy specimens were also obtained from 11 normal subjects.
Periodic acid–Schiff staining determined the number of goblet cells
present. Immunofluorescence microscopy for Ki-67 localization was used to
evaluate the number of actively cycling cells.
Results Periodic acid–Schiff staining showed fewer goblet cells at baseline
in both dry eye populations when compared with normal subjects (P<.001). After 6 months of CsA treatment, conjunctival biopsy specimens
of both NSS-KCS and SS-KCS groups revealed an increase in goblet cells compared
with baseline (P<.05). More Ki-67–positive
cells were observed in NSS-KCS conjunctiva at baseline than in normal conjunctiva
(P<.05) whereas numbers of these cells in SS-KCS
conjunctiva were similar to normal at baseline. After 6 months of CsA treatment,
conjunctival biopsy specimens of NSS-KCS revealed a decrease in Ki-67–labeled
cells compared with baseline (P<.001). In contrast,
no substantial change was observed for CsA treatment in patients with SS-KCS.
Conclusions Treatment of dry eye syndrome for 6 months with topical CsA resulted
in an increase in goblet cell numbers in patients with NSS-KCS and SS-KCS
and a decrease in epithelial turnover in those with NSS-KCS. Reducing ocular
surface inflammation might have an effect on the proliferative activity of
the epithelium.
From the Schepens Eye Research Institute and Department of Ophthalmology,
Harvard Medical School, Boston, Mass.
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