Clinical significance of corneal confocal microscopy characteristics and inflammatory cytokines in Sjögren's syndrome-related dry eye disease

OBJECTIVE: confocal microscopy (IVCM) - derived corneal immune - neural metrics, and systemic cytokines and ocular surface findings in Sjögren's syndrome-associated dry eye disease (SS-DED), and to identify variables independently associated with SS-DED status. METHODS: A retrospective case - control study was conducted (Jan 2019 - Jan 2022), including 120 SS-DED patients and 88 healthy controls. Corneal dendritic cell density (DCD), inflammatory cell density (ICD), and nerve fiber density (NFD) were quantified by IVCM. Tear break-up time (BUT), corneal fluorescein staining (FL), Schirmer test, and Ocular Surface Disease Index (OSDI) were assessed using standard protocols. Variables independently associated with SS-DED were identified using multivariable logistic regression, and their discrimination performance was evaluated using receiver operating characteristic (ROC) analysis. RESULTS: Compared to controls, SS-DED patients showed significantly higher levels of IL-1β, IL-6, TNF-α, DCD, and ICD, and lower NFD levels (all P