Purpose. To describe corneal morphological changes by evaluating Langerhans cell (LC) and endothelium cell density using in vivo laser scanning confocal microscopy (LSCM) in herpes simplex virus (HSV) keratitis during acute phase of the disease and after 6 months, to compare with contralateral eyes, controls with previous history of herpes labialis and healthy controls. Methods A prospective clinical study included 79 patients with herpetic eye disease, 101 healthy patients with previous history of herpes labialis but no history of herpetic eye disease, and 89 patients with no history of any HSV diseases. All patients underwent a complete ophthalmological examination including LSCM of the central cornea, using the Heidelberg Retina Tomograph III Rostock Cornea Module. After 6 months, the same ophthalmological examination was performed for patients with herpetic eye disease. Serology tests of the serum to detect HSV 1/2 IgG and IgM using Virion Serion ELISA classic kit were performed. Results HSV affected eyes showed an increase in LC density when compared with contralateral eyes, herpes labialis, and healthy control groups (357.9±308.7 vs. 197.1±258.5 vs. 62.9±72.6 vs. 81.7±88.3) (p<0.05). Higher LC density and less density of corneal sub-basal nerve parameters were found (p<0.05). Endothelium density in HSV affected eyes did not differ from the contralateral eyes, but it was lower when comparing with herpes labialis patients and healthy controls (2300.7±530.6 vs. 2343.3±543.7 vs. 2672.9±268.1 vs. 2620.9±347.1) (p<0.05). After 6 months, LC density in HSV affected eyes decreased but did not reach those of healthy controls (p<0.05). Conclusions LSCM reveals a significant increase of LC and decrease of endothelium cell density in HSV affected corneas. The decrease in LC density is a clear, indirect sign of recovery, which can be used in clinical practice.
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