Correlations between tear lymphocytotoxin-a (LT-α) level and disease severity in adult keratoconus

Xiuxian Qin; Shunrong Luo; Xie Fang; Xianwen Xiao; Zhiwen Xie; Xumin Shang; Juan Yang; Xi Lan; Huping Wu; Zhirong Lin

doi:10.3389/fmed.2025.1591159

Correlations between tear lymphocytotoxin-a (LT-α) level and disease severity in adult keratoconus

Front Med (Lausanne). 2025 Jun 6:12:1591159. doi: 10.3389/fmed.2025.1591159. eCollection 2025.

Authors

Xiuxian Qin^{1

2}, Shunrong Luo¹, Xie Fang¹, Xianwen Xiao¹, Zhiwen Xie¹, Xumin Shang¹, Juan Yang¹, Xi Lan¹, Huping Wu^{1

3

4

5

5

5}, Zhirong Lin^{1

3

4

5

5

5}

Affiliations

¹ Xiamen Eye Center and Eye Institute of Xiamen University, Xiamen, China.
² Guangzhou Huangpu Aier Eye Hospital, Guangzhou, China.
³ Xiamen Clinical Research Center for Eye Diseases, Xiamen, China.
⁴ Xiamen Key Laboratory of Ophthalmology, Xiamen, China.
⁵ Fujian Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, China.

Abstract

Purpose: This study aimed to investigate tear lymphocytotoxin-α (LT-α) levels in adult keratoconus patients and identify the correlations between LT-α and the disease severity of keratoconus.

Methods: In this cross-sectional study, tear samples from 100 keratoconus patients (KC group) and 67 healthy controls (HC group) were collected. LT-α levels were tested immediately after collection using a commercially available point-of-care test (POCT). Visual acuity, corneal tomography, anterior segment optical coherence tomography (AS-OCT), tear film parameters, including non-invasive break-up time (NI-BUT), tear meniscus height (TMH), lipid layer thickness (LLT), and meibomian glands, were also tested. Corneal topography values (K1, K2, K_max, and astigmatism) were derived from the tomography data.

Results: The tear LT-α levels in the HC group were significantly higher than those in the KC group (p = 0.038). The NI-BUT, TMH, and LLT were significantly lower, while the meiboscore was higher in the KC group than in the HC group (p < 0.001). In the KC group, patients were further divided into preclinical stage, initial stage, and complete stage groups. Significant differences in tear LT-α levels were found among the three subgroups. Within the KC group, LT-α levels were significantly correlated with various parameters, including thinnest corneal thickness, best-corrected visual acuity (BCVA) (LogMAR), K1, K2, K_max, and astigmatism values. However, no significant correlation was observed between the tear LT-α level and tear film parameters. Within the control group, no significant correlation was identified between the tear LT-α level and corneal topography or tear film parameters.

Conclusion: Our data demonstrated an association between tear LT-α levels and the severity of keratoconus, implying that immune-related factors may be involved in the pathogenesis and progression of the disease.

Keywords: corneal tomography; inflammation; keratoconus; lymphotoxin-α (LT-α); point-of-care test; tear film.