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K Kurteeva, JC Affeldt, T Albini, MR Agarwal; Fibrillary Lines; New Clinical, Ultrustructure, and Theoretic Observations . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1663.
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Purpose: Fibrillary lines describe a rarely reported and poorly understood superficial corneal entity observed in both normal and keratoconic eyes, and are postulated to represent corneal nerves. The purpose of this report is to document fibrillary lines in a previously undescribed clinical setting, and to describe their first ultrastructural analysis. Methods: Retrospective chart review. Corneal sensation was quantitated using the Cochet-Bonnet esthesiometer, and values compared to 32 normal control eyes. Corneal biopsy was performed on 2 eyes with #15 blade epithelial scraping under slit-lamp control. Tissues were fixed in 10% formalin, and processed for transmission electron-microscopy (TEM). Results: Three eyes were identified with fibrillary corneal lines. Two cases developed within 10 days and 4 months respectively of a previously unremarkable exam, while the third was documented on initial presentation. All cases were identified in association with advanced (4+) vortex patterned Stage I neurotrophic keratitis (punctate keratopathy). Mean central corneal sensation was profoundly depressed (0.33 mm) as compared to controls (56.3 mm, P=0.0001). In terms of location, extent, and orientation, the lines were morphologically identical to early or partially developed corneal verticillata. Following biopsy, the cornea slowly healed in both eyes without recurrence of pathologic lines, TEM results will be presented. Conclusion: Fibrillary lines are not only associated with but can develop rapidly in eyes exhibiting advanced states of Stage I neurotrophic keratitis, particularly those demonstrating vortex patterned epitheliopathy. Their morphologic similarity to the corneal verticillatas, at least in this series of patients, supports the classification of at least a subgroup of fibrillary lines as a neurotrophically derived variant of the corneal verticillata or vortex dystrophy. In this regard, fibrillary lines would represent junctional fronts of differentially migrating neurotrophically injured epithelial cells as opposed to corneal nerves.
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