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Roxanna Pourmirzaie, Rodrigo T Muller, Shruti Aggarwal, Arsia Jamali, Bernardo Menelau Cavalcanti, Deborah Langston, Pedram Hamrah; In Vivo Confocal Microscopy Demonstrates Bilateral Loss of Corneal Endothelial Cells in Unilateral Herpes Simplex Keratitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1471.
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© ARVO (1962-2015); The Authors (2016-present)
Herpes simplex virus (HSV) keratitis is the most common cause of unilateral corneal blindness in the Western hemisphere. This study utilizes in vivo confocal microscopy (IVCM) to analyze bilateral corneal endothelial cell density as correlated to subbasal nerve changes in patients with a unilateral stromal scar due to HSV keratitis.
A prospective, cross-sectional study was performed with 39 patients with a clinical diagnosis of unilateral HSV keratitis, contralateral eye clinically unaffected, and 24 age-matched normal controls. Laser IVCM with Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (HRT3/RCM) of central cornea was performed bilaterally in all patients and controls. Patients with diabetes mellitus, history of non-herpetic infectious keratitis, intraocular surgery endotheliitis were excluded from the analysis. Confocal images were analyzed by two blinded observers for endothelial cell density, subbasal nerve length, and density. For each variable, results were averaged and analyzed utilizing ANOVA and Pearson’s correlation coefficient.
In patients with HSV keratitis, the mean endothelial cell density in the affected eye was significantly lower than in age-matched controls (2355±584 vs. 3185±215 cells/mm2, p<0.0001). Surprisingly, the contralateral, clinically unaffected eye also demonstrated lower endothelial cell density compared with control group (2599±385 cells/mm2, p<0.001). There was no significant difference in endothelial cell density between the affected and the unaffected contralateral eye (p=0.17). Both affected and contralateral unaffected eye showed decrease in total nerve density compared to controls (10,028±1069 μm/mm2, 17,675±6336 and 23,811±703, respectively, p<0.0001). A positive correlation was found between endothelial cell density (cells/mm2) with respect to: main trunk nerve density (μm/mm2, p<0.0001, r=0.66), branch nerve density (μm/mm2, p<0.0001, r=0.62) and total nerve density (nerves/frame p<0.0001, r=0.68).
Compared to controls, patients with unilateral HSV keratitis demonstrate a significant decrease in corneal endothelial cell density in both the affected eye, and intriguingly, the unaffected eye. Corneal endothelial cell density is also correlated with decrease in corneal subbasal nerves, suggesting potential link between corneal innervation and corneal endothelial cell homeostasis.
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