In vivo confocal microscopic evaluation of the inflammatory response in non-epithelial herpes simplex keratitis.
OBJECTIVE
To investigate the characteristics of the inflammatory response detected in corneas with active non-epithelial herpes simplex virus (HSV) keratitis.


METHODS
The study was designed as a cross-sectional study undertaken at a university setting. Twenty-one eyes of 21 patients with a mean age of 40.1 ± 13.0 years (range: 18-70 years) and whose corneal findings were compatible with active HSV keratitis were included. All patients were evaluated with in vivo confocal microscopy (Confoscan 3, Nidek). Fifty healthy, age-matched subjects served as controls. The features and extent of corneal inflammation, degree of involvement of subbasal nerve plexus and endothelial cell density were evaluated.


RESULTS
Seven eyes (33.3%) demonstrated stromal keratitis, six (28.6%) endotheliitis and eight (38.1%) presented with keratouveitis. Intraepithelial inflammatory cell infiltration, consisting of dendritic and small round cells, was observed in 11 eyes (52.4%). Stromal involvement was detected in 95.2% of eyes in the form of focal and diffuse cellular infiltrates; of these, anterior, posterior and pan stromal infiltration was observed in 85.7, 71.4 and 47.6% of cases, respectively. No particular keratic precipitate morphology was found to be diagnostic for HSV keratitis. The mean endothelial cell density of eyes with HSV keratitis (2437 ± 599 cells/mm(2)) was significantly lower (-18.8%) than that of controls (3003 ± 250 cells/mm(2)); (p < 0.001). The mean subbasal nerve density of patients with HSV keratitis (474.5 ± 227.8 μm/frame) was significantly lower than that of controls (1589.6 ± 499.0 μm/frame) (p < 0.001).


CONCLUSIONS
Non-epithelial HSV keratitis related inflammatory response is characterized by cellular infiltration of all corneal layers, attenuation of the subbasal nerve plexus and endothelial cell loss.
Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.
Mehmet C
MC
Mocan
Murat
M
Irkec
Dimitrios G
DG
Mikropoulos
Banu
B
Bozkurt
Mehmet
M
Orhan
Anastasios G P
AG
Konstas
D000293:Adolescent; D000328:Adult; D000368:Aged; D002452:Cell Count; D003315:Cornea / Q000294:innervation; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis*; D003319:Corneal Stroma / Q000473:pathology* / Q000821:virology; D003430:Cross-Sectional Studies; D019573:Epithelium, Corneal / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D016849:Keratitis, Herpetic / Q000175:diagnosis*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009415:Nerve Net; D012668:Trigeminal Ganglion / Q000473:pathology; D055815:Young Adult