In Vivo confocal microscopic changes of the corneal epithelium and stroma in patients with herpes zoster ophthalmicus.
OBJECTIVE
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.


METHODS
Prospective, controlled and masked cross-sectional study.


METHODS
setting: Single-center study.


METHODS
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.


METHODS
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/mm(2)) was significantly lower than both healthy control eyes (1450.23 ± 150.83 cells/mm(2)) and contralateral unaffected eyes (1974.13 ± 298.24 cells/mm(2)) (P = .003). Superficial epithelial cell size (1162.5 μm(2)) was significantly larger in HZO eyes with severe loss of sensation, as compared to contralateral (441.46 ± 298.14) or healthy eyes (407.4 ± 47.2μm(2); 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.
Ocular Surface Imaging Center, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. Electronic address: pedram_hamrah@meei.harvard.edu.
Pedram
P
Hamrah
Ocular Surface Imaging Center, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Afsun
A
Sahin
Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Mohammad H
MH
Dastjerdi
Ocular Surface Imaging Center, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Bashar M
BM
Shahatit
Ocular Surface Imaging Center, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Hasan A
HA
Bayhan
Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Reza
R
Dana
Cornea and Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Deborah
D
Pavan-Langston
D002452:Cell Count; D003315:Cornea / Q000294:innervation; D060527:Corneal Keratocytes / Q000473:pathology*; D003319:Corneal Stroma / Q000473:pathology*; D003389:Cranial Nerve Diseases / Q000473:pathology; D003430:Cross-Sectional Studies; D019573:Epithelium, Corneal / Q000473:pathology*; D015828:Eye Infections, Viral / Q000473:pathology*; D005260:Female; D006563:Herpes Zoster Ophthalmicus / Q000473:pathology*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009882:Ophthalmic Nerve / Q000821:virology; D011446:Prospective Studies