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K.K. Chang, J.C. Affeldt, L. Labree, M. Agarwal; Noninfectious Pseudodendritic Keratitis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2954.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To document for the first time the clinical characteristics of a distinctive variant of neurotrophic keratitis (termed here noninfectious pseudodendritic keratitis) which masquerades as dendritic herpes keratitis. Methods:Observational case series. Results:Ten eyes of the 9 patients presented with a branching epitheliopathy closely resembling dendritic herpes keratitis. Five patients were undergoing topical and/or systemic antiviral therapy at the time of initial exam. In all cases, the lesions were manifested by opaque whitish elevated epithelial cell congregations which formed rough branching dendritic figures without terminal bulbs. All lesions were limited to the inferior or inferocentral cornea, with the long axis of branches oriented at 180 degrees. In addition, all lesions stained with fluorescein, and were found to be broadly surrounded by a dense field of punctate keratopathy. Average central cornal sensation (Cochet–Bonnet esthesiometer) was significantly reduced as compared to controls (6.3 mm versus 56.3 mm; P=0.0001), reflecting a neurotrophic environment. In all cases the lesions rapidly resolved with discontinuation of antivrial therapy coupled with aggressive lubrication and punctal occlusion. Conclusions:Noninfectious pseudodendritic keratitis appears to represent a neurotrophically generated variant of vortex keratopathy (cornea verticillata) which can be easily confused with dendritic herpes simplex or zoster keratitis. It can be distinguished from its infectious counterparts however by its distincitive clinical presentation including lesion color, location, orientation, and presence of surrounding punctate keratopathy field, as well as its rapid response to aggressive punctal occlusion.
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