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2010 OMIG, Abstract 24

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In vivo confocal microscopy reveals bilateral increase in epithelial dendritic cell density correlating with the diminishment of subbasal nerve plexus in patients with unilateral herpes simplex keratitis
A. Cruzat,1 D. Witkin,1 N. Baniasadi,1 L. Zheng,2 D. Pavan-Langston,1 P. Hamrah.1,21Cornea Service and Ocular Surface Imaging Center, Massachusetts Eye & Ear Infirmary, Dept. of Ophthalmology, Boston, MA, 2 Immune Disease Institute, Harvard Medical School, Boston, MA

Purpose: To study the density of epithelial dendritic cells (DC) as correlated to subbasal corneal nerve alterations in herpes simplex keratitis (HSK) by laser in vivo confocal microscopy (IVCM).
Methods: A prospective study was performed in patients with HSK (n= 34). Laser IVCM with the Heidelberg Retina Tomograph 3 with the Rostock Cornea Module of the central cornea was performed in 34 eyes with HSK, in their contralateral clinically unaffected eyes, and in 20 eyes of 20 normal controls. Two masked observers reviewed and correlated the images for central corneal DC density, subbasal nerve density, main nerve trunks, branching and tortuosity. For each variable, results for three frames were averaged, and analyzed utilizing student´s T-test, analysis of variance (ANOVA) and Pearson correlation coefficient.
Results: The mean epithelial DC density was significantly (p<0.0001) higher in patients with HSK (192.3±138.8 cells/mm2) as compared to controls (49.35±39.6 cells/mm2). Surprisingly, in the contralateral clinically unaffected eyes, DC density was significantly (p<0.002) increased as well (153.3±160 cells/mm2). The increase in epithelial DC density in both HSK and their contralateral eyes, was associated with diminishment in nerve density (1280.3±1007 vs. 2170.4±884 vs. 3774.8±477 μm/frame, respectively p<0.001) (r=-0.4, p<0.05), total number of nerves (5.1 vs. 10.2 vs. 20.1, respectively p<0.001) (r=-0.4, p<0.05), main trunks (2.6 vs. 4.3 vs. 6.7, respectively p<0.001) (r=-0.1, p=n.s.), and branching (1.9 vs. 5.2 vs. 13.4, respectively p<0.001) (r=-0.5, p<0.05) as compared to normal controls.
Conclusions: IVCM reveals an increased density of central epithelial DC in HSK as well as in the contraleteral unaffected eyes. This increase in DC density is strongly associated with the diminishment of the subbasal corneal nerves both in the affected eye and in the contralateral unaffected eye, suggesting a direct interaction between the immune and nervous system in the cornea and a bilateral nerve and immune alteration in an apparently unilateral disease.
Support: NIH K08-EY020575, New England Corneal Transplant Research Fund, Falk Medical Research Trust.

Disclosure Code: N

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