Increased corneal sub‐basal nerve density in patients with Sjögren syndrome treated with topical cyclosporine A

Abstract Background To evaluate quantitative and qualitative changes in sub‐basal corneal nerves (SBN) via in vivo confocal microscopy in patients with Sjögren syndrome dry eye (SSDE) treated with topical cyclosporine A (CsA). Design Prospective, observational, non‐randomized study. Participants Thirty eyes of 30 patients with SSDE refractory to conventional treatment treated with CsA 0.05% twice daily for 6 months. Fifteen eyes of 15 healthy, age and gender matched, volunteers constituted the control group at baseline. Methods A clinical evaluation of dry eye, corneal sensation using Cochet–Bonnet esthesiometry and in vivo confocal microscopy analysis of the central cornea were performed prospectively at baseline for all patients, and after 6 months of treatment with CsA. Main outcome measures Density, number, reflectivity and tortuosity of SBN, dendritic cell (DC) density, esthesiometry, and dry eye signs and symptoms. Results Topical CsA 0.05% improved clinical signs and symptoms, and increased corneal sensitivity. Following treatment, SBN density was significantly increased ( P < 0.0001) associated with a decreased in DC density ( P < 0.0001). The increase in SBN density after treatment was positively correlated with baseline SBN density ( R 2 = 0.33; P = 0.0008) and negatively correlated with baseline Ocular Surface Disease Index ( R 2 = 0.28; P = 0.002), Oxford score ( R 2 = 0.31; P = 0.002), and DC density ( R 2 = 0.37; P = 0.0003). Conclusions Topical CsA led to an increase in corneal SBN density, improving clinical signs and symptoms of SSDE. Our results also suggest an improved response to treatment in patients with less initial nerve damage.