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T. Hillenaar, R. Wubbels, C. Weenen, L. Remeijer; Endothelial Involvement in Herpes Simplex Virus Keratitis: An in vivo Confocal Microscopy Study. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2808. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the specific characteristics of corneal endotheliitis in human herpes simplex virus (HSV) keratitis as seen by in vivo confocal microscopy (IVCM).
200 consecutive patients with HSV keratitis visiting the corneal department of the Rotterdam Eye Hospital between May 2005 and November 2007 have been repeatedly examined by IVCM. The patients’ corneas were scanned either with the Confoscan 3 or the Confoscan 4. (Nidek Technologies, Albignasego, Padova, Italy). In n=58 the viral origin was culture or PCR proven. In all other cases the diagnoses were based on clinical history and standardized slit lamp examination by an experienced corneal specialist (L.R.). The IVCM exams were qualitatively reviewed for signs of endothelial deviations that are considered characteristic for endotheliitis. In n=18 endothelial visualisation was impossible due to dense stromal maculae.
In 57 eyes of 200 HSV patients (29%) endothelial alterations were detected that can be ascribed to endotheliitis. These deviations consisted of intercellular gaps, guttata-like lesions, spot-like holes, loss of defined cell boundaries and endothelial denudation. In 2 patients a breakthrough in descemet's membrane could be identified.
To our knowledge, the present study is the first to describe the appearance of corneal endotheliitis in human HSV keratitis as seen by in vivo confocal microscopy. IVCM may allow detection of corneal endotheliitis, even when slight stromal opacification obscures the endothelium at slit lamp examination.
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