Corneal Sensation and Subbasal Nerve Alterations in Patients with Herpes Simplex Keratitis
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Author
Hamrah, Pedram
Dastjerdi, Mohammad H.
Zheng, Lixin
Shahatit, Bashar M.
Bayhan, Hasan A.
Pavan-Langston, Deborah
Published Version
https://doi.org/10.1016/j.ophtha.2010.07.010Metadata
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Hamrah, Pedram, Andrea Cruzat, Mohammad H. Dastjerdi, Lixin Zheng, Bashar M. Shahatit, Hasan A. Bayhan, Reza Dana, and Deborah Pavan-Langston. 2010. “Corneal Sensation and Subbasal Nerve Alterations in Patients with Herpes Simplex Keratitis.” Ophthalmology 117 (10) (October): 1930–1936. doi:10.1016/j.ophtha.2010.07.010.Abstract
PurposeTo study and correlate corneal sensation in patients with herpes simplex keratitis (HSK) with density and morphology of subbasal corneal nerves by in vivo confocal microscopy (IVCM).
Design
Prospective, cross-sectional, controlled, single-center study.
Participants
Thirty-one eyes with the diagnosis of acute (n=7) or chronic (n=24) HSK and the contralateral clinically unaffected eyes were studied and compared to normal controls (n=15).
Methods
IVCM (Confoscan 4, Nidek) and corneal esthesiometry (Cochet-Bonnet) of the central cornea were performed bilaterally in all patients and controls. Patients were grouped into normal (>5.5 cm), mild (>2.5 to 5.5cm) and severe (≤2.5 cm) loss of sensation.
Main Outcome Measures
Changes in corneal nerve density, total nerve number, main nerve trunks, branching and tortuosity were evaluated after IVCM and correlated to corneal sensation, disease duration, and number of recurrences.
Results
HSK eyes, as compared to controls, demonstrated significant (p<0.001) decrease in mean nerve density (448.9±409.3 vs. 2,258.4±989.0 μm/frame), total nerve number (5.2±4.5 vs. 13.1±3.8), main nerve trunks (2.3±1.6 vs. 4.7±1.2) and nerve branches (3.2 ± 4.3 vs. 9.8±3.3). In contralateral unaffected eyes, mean nerve density (992.7±465.0 μm/frame), total nerve number (7.8±3.3), and branches (4.5±2.3) were significantly decreased as compared to controls (p<0.002). Reduced nerve density, total nerve count and main trunks in HSK eyes were significantly correlated with corneal sensation across all subgroups (p<0.001). Nerve density decreased within days of infection and was correlated to frequency of episodes in patients with HSK (p<0.02).
Conclusions
In vivo confocal microscopy reveals that the loss of corneal sensation in HSK correlates strongly with profound diminishment of the subbasal nerve plexus after herpes simplex virus (HSV) infection. Surprisingly, the contralateral clinically unaffected eyes also demonstrated a diminishment of the subbasal nerve plexus, as compared to normal subjects, revealing bilateral nerve alteration in an apparently unilateral disease.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949523/Terms of Use
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