title: Corneal Reinnervation and Sensation Recovery in Patients With Herpes Zoster Ophthalmicus: An In Vivo and Ex Vivo Study of Corneal Nerves.
abstract: OBJECTIVE
  To study corneal reinnervation and sensation recovery in Herpes zoster ophthalmicus (HZO).
  
  
  METHODS
  Two patients with HZO were studied over time with serial corneal esthesiometry and laser in vivo confocal microscopy (IVCM). A Boston keratoprosthesis type 1 was implanted, and the explanted corneal tissues were examined by immunofluorescence histochemistry for βIII-tubulin to stain for corneal nerves.
  
  
  RESULTS
  The initial central corneal IVCM performed in each patient showed a complete lack of the subbasal nerve plexus, which was in accordance with severe loss of sensation (0 of 6 cm) measured by esthesiometry. When IVCM was repeated 2 years later before undergoing surgery, case 1 showed a persistent lack of central subbasal nerves and sensation (0 of 6). In contrast, case 2 showed regeneration of the central subbasal nerves (4786 μm/mm) with partial recovery of corneal sensation (2.5 of 6 cm). Immunostaining of the explanted corneal button in case 1 showed no corneal nerves, whereas case 2 showed central and peripheral corneal nerves. Eight months after surgery, IVCM was again repeated in the donor tissue around the Boston keratoprosthesis in both patients to study innervation of the corneal transplant. Case 1 showed no nerves, whereas case 2 showed new nerves growing from the periphery into the corneal graft.
  
  
  CONCLUSIONS
  We demonstrate that regaining corneal innervation and corneal function are possible in patients with HZO as shown by corneal sensation, IVCM, and ex vivo immunostaining, indicating zoster neural damage is not always permanent and it may recover over an extended period of time.
authors.affiliation: *Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA;†Department of Ophthalmology, Pontificia Universidad Católica de Chile, Santiago, Chile;‡New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA;§Eye Center, Somerville Hospital, Department of Surgery, Cambridge Health Alliance, Somerville, MA; and¶Department of Ophthalmology, University of Chicago, Chicago, IL.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cruzat
authors.forename: Pedram
authors.initials: P
authors.lastname: Hamrah
authors.forename: Bernardo M
authors.initials: BM
authors.lastname: Cavalcanti
authors.forename: Lixin
authors.initials: L
authors.lastname: Zheng
authors.forename: Kathryn
authors.initials: K
authors.lastname: Colby
authors.forename: Deborah
authors.initials: D
authors.lastname: Pavan-Langston
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001187:Artificial Organs; D003315:Cornea / Q000294:innervation*; D015828:Eye Infections, Viral / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006563:Herpes Zoster Ophthalmicus / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D018613:Microscopy, Confocal; D009416:Nerve Regeneration / Q000502:physiology*; D019919:Prosthesis Implantation; D020127:Recovery of Function / Q000502:physiology; D012677:Sensation / Q000502:physiology; D014276:Trigeminal Nerve / Q000502:physiology*; D014404:Tubulin / Q000378:metabolism; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; C498585:TUBB3 protein, human; D014404:Tubulin; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir