Ocular Microbiology and Immunology Group
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2012 OMIG Abstract 9

Corneal Nerves Regenerate in Patients with Herpes Zoster Ophthalmicus and may be Accelerated by Treatment with Autologous Serum Tears
P. Hamrah, A. Cruzat, B. Cavalcanti, D. Pavan-Langston.
Cornea Service and Ocular Surface Imaging Center, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA

Purpose: To study potential corneal reinnervation and recovery of corneal sensation in patients with Herpes zoster ophthalmicus (HZO) and their response to treatment with autologous serum tears.

Methods: Six cases of HZO with severe neurotrophic keratopathy followed clinically and by serial in vivo confocal microscopy (IVCM) and Cochet-Bonnet corneal esthesiometry (0-6 cm). A Boston keratoprosthesis type 1 was implanted in the affected eyes of two patients due to corneal scarring. The explanted corneal tissue was examined by immunofluorescence histochemistry for ß-tubulin to stain for corneal nerves. Serial IVCM was performed prior to surgery and 1 year after surgery to study innervation of the corneal transplant. Four patients were treated with 20% autologous serum tears 8x/day and followed clinically and by IVCM.

Results: The initial IVCM performed in each patient, showed a complete lack of the subbasal corneal nerve plexus, which was in accordance with the absolute loss of sensation (0 cm). In the two patients undergoing surgery, repeated IVCM after 2 years, demonstrated persistent lack of central subbasal nerves and no sensation in one patient, while the second patient showed visible subbasal nerves (4,786 μm/mm²) with partial recovery of corneal sensation (2.5 cm) after 5 years. Immunostaining of the explanted corneal buttons showed no central corneal nerves, but a few peripheral stromal nerves in one patient, and both central and peripheral corneal nerves in the second patient. All four patients treated with autologous serum tears, demonstrated significant and rapid nerve regeneration by IVCM within 1-3 months of treatment (mean 14152 μm/mm²), as well as some recovery of corneal sensation (mean 2 cm). However, 3 of 4 patients developed necrotizing stromal keratitis within weeks after nerve regeneration in the absence of steroids or if steroids were withdrawn. When treatment with serum tears was restarted with concurrent use of low dose topical steroids, no stromal keratitis was observed.

Conclusions: We demonstrate that regaining corneal innervation and function is possible in patients with HZO and can be accelerated with autologous serum tears, challenging a long-standing dogma. Corneal nerve regeneration by nerve growth factors in autologous serum tears may result in stromal keratitis in HZO patients, should be used with caution, and may require concurrent local immunosuppression.

Disclosure: NIH K08-EY020575 (PH), Research to Prevent Blindness Career Development Award (PH), Falk Medical Research Foundation (PH).

2012 Agenda and Abstracts | < Previous | Next >