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2011 OMIG Abstract 17

In vivo confocal microscopy in epidemic keratoconjunctivitis  (EKC) demonstrates increased corneal epithelial dendritic cells and loss of the subbasal nerve plexus
A. Cruzat, E. Samayoa, M. Bronikowska, P. Hamrah
Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye & Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, MA

Purpose: To study the subbasal corneal nerve changes and function, as well as alterations in epithelial dendritic cell (DC) density and morphology in acute EKC by laser in vivo confocal microscopy (IVCM).

Methods: A prospective study was performed in 20 eyes of 10 patients with acute bilateral EKC, as well as in 20 normal eyes of 20 healthy controls. We measured central corneal sensation with the cochet-bonnet esthesiometer and performed IVCM of the central cornea with the Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (HRT3/RCM, Heidelberg Engineering, GmbH). Two masked observers reviewed the IVCM images and analyzed the subbasal nerve plexus length and numbers and the density and morphological characterization of central corneal DC.

Results: We found a significant diminishment of the subbasal nerve plexus, as compared to normal controls, in total nerve length (2014.8±1248.2 vs. 3652.8±596.3 µm/frame; p<0.0001), total number of nerves (10.8±7.3 vs. 20.8±4.1; p<0.0001), main nerve trunks (1.9±1.1 vs. 6.2±1.0; p<0.0001) and branch nerve length (1244.3±861.9 vs. 1718.1±486.9; p=0.02). In addition, corneal sensation was decreased in eyes with EKC as compared to controls (p<0.0001). Further, IVCM showed a significant increase in DC density (220±161 vs. 49.3±39.6 cells/mm2; p<0.05) with a significant change of the DC morphology, cell body size (230.5±117.1 vs. 81.7±23.8 µm2; p<0.0001), number of dendrites per cell (4.7±0.7 vs. 3.7±0.4; p<0.0001) and corneal area covered by each cell (883.5±557.0 vs. 245.6±120.8; p<0.0001), as compared to normal controls.

Conclusions: IVCM demonstrates significant nerve and immune alterations in eyes with acute adenoviral keratitis. We observed a considerable decrease in the subbasal corneal nerve plexus and corneal sensation, which was associated with an increase in DC density and size in eyes of patients with EKC. These findings suggest that limiting inflammation in the acute phase of EKC through anti-inflammatory therapy may be beneficial through preservation of corneal nerves and their function, and ultimately the prevention of long-term sequelae, such as dry eyes.

Support: NIH K08-EY020575, NIH K12-EY016335, New England Corneal Transplant Research Fund, Falk Medical Research Trust

Disclosure: N

2011 Abstract List | < Previous | Next >