title: In Vivo Confocal Microscopy Demonstrates Bilateral Loss of Endothelial Cells in Unilateral Herpes Simplex Keratitis.
abstract: OBJECTIVE
  To report bilateral corneal endothelial cell density (ECD), as well as its correlation with subbasal nerve changes, in patients with unilateral herpes simplex keratitis (HSK).
  
  
  METHODS
  Thirty-six eyes of 36 patients with corneal scarring caused by HSK, as well as their respective contralateral clinically unaffected eyes, were prospectively studied and compared with 26 eyes of 26 healthy volunteers. In vivo confocal microscopy and corneal sensation of the central cornea were performed bilaterally in all patients and in one random eye of controls. The ECD and subbasal corneal nerve density, including the lengths of total nerves, main trunks, and branches were evaluated and correlated to central corneal sensation.
  
  
  RESULTS
  The ECD was significantly lower in eyes affected with HSK than in controls (2304 ± 578 vs. 2940 ± 370 cells/mm(2), P < 0.0001). Surprisingly, lower ECD was also detected in contralateral clinically unaffected eyes (2548 ± 423), compared to controls (P = 0.02). Both affected and contralateral eyes showed decrease in total nerve length, compared to controls (10.0 ± 6.3 vs. 17.6 ± 6.3 vs. 21.9 ± 4.3 mm/mm2, respectively; P < 0.05 for all). The ECD correlated positively with total nerve length (r = 0.39, P = 0.0009) and with corneal sensation (r = 0.31, P = 0.009).
  
  
  CONCLUSIONS
  In vivo confocal microscopy findings demonstrated alterations in corneal ECD in both affected and clinically unaffected contralateral eyes of patients with unilateral HSK. Moreover, the positive significant correlation between the ECD and the subbasal nerve density may suggest a potential link between corneal innervation and corneal endothelial cell homeostasis.
authors.affiliation: Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Rodrigo T
authors.initials: RT
authors.lastname: Müller
authors.affiliation: Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Roxanna
authors.initials: R
authors.lastname: Pourmirzaie
authors.affiliation: Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Deborah
authors.initials: D
authors.lastname: Pavan-Langston
authors.affiliation: Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Bernardo M
authors.initials: BM
authors.lastname: Cavalcanti
authors.affiliation: Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Shruti
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Clara
authors.initials: C
authors.lastname: Colón
authors.affiliation: Schepens Eye Research Institute, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Arsia
authors.initials: A
authors.lastname: Jamali
authors.affiliation: Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cruzat
authors.affiliation: Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, United States 2Schepens Eye Research Institute, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medic.
authors.forename: Pedram
authors.initials: P
authors.lastname: Hamrah
mesh_terms: D002452:Cell Count; D003315:Cornea / Q000294:innervation* / Q000473:pathology; D003430:Cross-Sectional Studies; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D016849:Keratitis, Herpetic / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012677:Sensation / Q000502:physiology*