In Vivo Confocal Microscopic Changes of the Corneal Epithelium and Stroma in Patients With Herpes Zoster Ophthalmicus

Abstract

Purpose To analyze the density and morphology of corneal epithelial cells and keratocytes by in vivo confocal microscopy (IVCM) in patients with herpes zoster ophthalmicus (HZO) as associated with corneal innervation. Design Prospective, controlled and masked cross-sectional study. Methods SETTING: Single-center study. PATIENTS: Thirty eyes with the diagnosis HZO and their contralateral clinically unaffected eyes, 15 eyes of 15 normal controls. INTERVENTION PROCEDURES: In vivo confocal microscopy and corneal esthesiometry of the central cornea. MAIN OUTCOME MEASURES: Changes in morphology and density of the superficial and basal epithelial cells and stromal keratocytes, and correlation with corneal sensation. Results The density of superficial epithelial cells in HZO eyes with severe sensation loss (766.5 ± 25.2 cells/mm2) was significantly lower than both healthy control eyes (1450.23 ± 150.83 cells/mm2) and contralateral unaffected eyes (1974.13 ± 298.24 cells/mm2) (P = .003). Superficial epithelial cell size (1162.5 μm2) was significantly larger in HZO eyes with severe loss of sensation, as compared to contralateral (441.46 ± 298.14) or healthy eyes (407.4 ± 47.2mm2; all P < .05). The density of basal epithelial cells, anterior keratocytes, and posterior keratocytes did not show statistical significance between patients, controls, and contralateral unaffected eyes. Changes in superficial epithelial cell density and morphology correlated strongly with corneal sensation. Conclusions In vivo confocal microscopy reveals profound HZO-induced changes in the superficial epithelium, as demonstrated by increase in cell size, decrease in cell density, and squamous metaplasia. We demonstrate that these changes strongly correlate with changes in corneal innervation in eyes affected by HZO.

Corneal nerves in health and disease

“…In herpes zoster virus keratitis (HZVK), the reduction of sub-basal nerve density is strongly linked to the profound changes in corneal epithelium e.g. increase cell size, decrease epithelial cell density and squamous metaplasia (Hamrah et al, 2015). The recovery of corneal sensation and innervation is possible, though many years after the last infection episode (Cruzat et al, 2016).…”

Comparison of Standard Versus Wide-Field Composite Images of the Corneal Subbasal Layer by In Vivo Confocal Microscopy

“…[10][11][12][13] Furthermore, in addition to providing trophic and sensory functions, corneal nerves have been shown to play an important role in the maintenance of ocular surface epithelial health and function. [14][15][16][17] As epithelial DCs and subbasal nerves may change in a variety of ocular surface and corneal conditions, such as dry eye disease, neurotrophic keratopathy, infectious keratitis, diabetes, and contact lens wear, 3,5,[18][19][20][21][22] quantification of these two structures, which can be achieved by IVCM, is of significant importance. The high resolution of IVCM images is inherently associated with a drawback, which is a relatively small field of view of the images.…”

Histomorphological view of the cornea investigated by laser confocal microscopy in keratoplasty

“…В последнее время широко применяют КМР для оценки заболеваний роговицы и поверхности глаза. Также технология позволяет визуализировать микроструктурные изменения, включая патогенные организмы, иммунные и воспалительные клетки, присутствующие в роговице [14,[17][18][19][20][21][22][23] Офтальмология вызывается двумя различными типами аллосенсибилизации: прямым и непрямым путями. В прямом пути участвуют Т-клетки, которые непосредственно отвечают на чужеродные молекулы MHC, экспрессируемые донорскими АПК.…”