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N. Amar, A. Labbe, C. Baudouin, S. Doan, B. Dupas, T. Hoang Xuan, E. Gabison; Thygeson Superficial Punctate Keratitis: An Evaluation With in vivo Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4309.
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To analyze corneal changes in patients with superficial punctate keratitis of Thygeson using in vivo confocal microscopy.
Twenty four eyes of 12 patients (7 females and 3 males) with Thygeson superficial punctate keratitis were included. Mean age was 30.2 years (ranged from 5 to 68 years). Slit-lamp biomicroscopy and in vivo confocal microscopy with HRT II/ Rostock cornea module were performed.
In all patients, slit-lamp biomicroscopy of Thygeson’s superficial punctate keratitis revealed epithelial cell clusters with a round - or oval- shaped grey and granular appearance. Absence of conjunctival or corneal inflammation and/ or scarring was noted in all patients. In vivo confocal microscopy images showed in the superficial epithelium round and/or oval shaped zones of hyper-reflective and abnormal epithelial cells. Deeper in the anterior stroma, round areas of hyper-reflective keratocytes were observed under the epithelial lesions. The corneal nerves seemed unmodified. Abundant dendriform cells were detected in the affected subepithelial area.
Thygeson superficial keratitis is described as a non inflammatory disease, a condition with transient, typically bilateral, coarse corneal epithelial opacities, without associated stromal involvement. In this study, we observed numerous inflammatory cells in the epithelium associated with hyper-reflective epithelial structures. Additionally, although no corneal scarring is usually described following this form of keratitis, activated keratocytes were constantly detectable in the subepithelial stroma. Thus in vivo confocal microscopy revealed epithelial and stromal changes compatible with an inflammatory involvement.
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