In Vivo Confocal Microscopy Demonstrates Bilateral Corneal Endothelial Cell Loss in Patients with Unilateral Herpes Zoster Ophthalmicus

Abstract

Purpose : To investigate bilateral corneal endothelial cell density (ECD), as well as its correlation with scar location and corneal nerve alterations in patients with unilateral herpes zoster ophthalmicus (HZO).

Methods : Twenty-eight eyes of 28 patients with corneal scarring caused by HZO, as well as their respective contralateral clinically unaffected eyes, were prospectively studied and compared with 24 eyes of 24 healthy volunteers. In vivo confocal microscopy (IVCM) and corneal sensation of the central cornea were performed bilaterally in all patients and in one random eye of controls. The ECD was correlated to subbasal corneal nerve density, including the total length of nerves, main trunks, and branches, central corneal sensation, and scar location (peripheral vs. central).

Results : The ECD was significantly lower in eyes affected with HZO than in controls (2,351.0 ± 343.2 vs. 3,185.0 ± 215.7 cells/mm², P < 0.0001). Surprisingly, lower ECD was also detected in contralateral clinically unaffected eyes (2,394.7 ± 330.9 cells/mm²), compared to controls (P < 0.001). Eyes with central HZO scars had a significantly lower ECD than eyes with peripheral scars (2,219.7 ± 434.6 cells/mm² vs. 2,446.4 ± 236.7 cells/mm², p<0.05). Both affected and contralateral eyes showed decreased total nerve length, compared to controls (6.1 ± 7.6 vs. 13.5 ± 10.9 vs. 17.8 ± 3.8 mm/mm², respectively; P < 0.05 for all). The ECD correlated positively with total nerve length (r = 0.32, P = 0.01) and with corneal sensation (r = 0.28, P = 0.02).

Conclusions : IVCM findings demonstrate bilateral alterations in corneal ECD in patients with unilateral HZO. Patients with central scars had a more profound loss of ECD than patients with peripheral scars. The positive significant correlation observed between the ECD and the subbasal nerve density may suggest a potential link between corneal innervation and corneal endothelial cell homeostasis.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.