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2015
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2015
OMIG Abstract 3
Effect of Corneal Scar Location in Patients with Herpes Simplex Keratitis on Bilateral Corneal Nerve Alteration: An In Vivo Confocal Microscopy Study
Chareenun Chirapapaisan, MD;1 Rodrigo T. Müller, MD;1,2 Andrea Cruzat, MD;1 Bernardo M. Cavalcanti, MD;1 Arsia Jamali, MD;1,2 Deborah Pavan-Langston, MD, FACS;1 Pedram Hamrah, MD, FACS.1,2
1Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, United States.
2Cornea Service and Boston Image Reading Center, New England Eye Center/Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States.
Purpose: Herpes simplex virus (HSV) can result in corneal scars in different locations. However it remains to be elucidated if the location of the scar has an effect on the degree of neurotrophic keratopathy. This study aimed to evaluate the effect of HSV corneal scar location on bilateral corneal nerve alteration and corneal sensation.
Methods: 39 patients with either unilateral central HSV scar (CS) or peripheral HSV scar (PS) and 24 normal controls were recruited in this prospective, cross-sectional study. Subbasal corneal nerves density and function were analyzed bilaterally, using laser in vivo confocal microscopy (IVCM) and corneal esthesiometry centrally and peripherally.
Results: The eyes with central and peripheral scars (CS and PS) revealed significant corneal nerve decrease in the central cornea (8.09±5.99 and 10.34±6.28 mm/mm2, p<0.0001) compared to controls (21.7±4.3). Similarly, they also showed significant subbasal nerve decrease in the periphery (p<0.0001) compared to controls (9.88±2.49). However, CS resulted in overall peripheral nerve decrease (5.15±2.81), whereas PS specifically affected only the affected peripheral area (4.22±3.08), but not the opposite side of the scar. Corneal sensation of CS and PS significantly decreased from normal (p<0.001) both centrally (3.61±2.26 and 3.02±2.2, p=0.08) and peripherally (3.55±2.0 and 2.61±2.0, p=0.46). In contralateral unaffected eyes, the nerve density was significantly lower in the central cornea of CS group (16.88±5.83, p< 0.05) and in the periphery of PS group, but only in the area corresponding to the scar of the affected eyes (7.20±3.48, p<0.05) compared to controls (center 21.73±4.37 and periphery 9.88±2.49). In contralateral eyes, significantly decreased corneal sensation was found only peripherally in the PS group, correlating with the scar area of the affected eyes (5.1, p<0.05).
Conclusions: The location of HSV corneal scars is related to bilateral corneal nerve decrease as shown by IVCM. CS and PS influenced the decrease of subbasal nerve density and corneal sensation in both central and peripheral cornea of the affected eyes. Interestingly, the diminishment of corneal nerves and sensation was found locally in the contralateral unaffected eyes of patients with PS, corresponding and mirroring with the scar location in the affected eyes.
Fundings: NIH K08-EY020575 (PH), Research to Prevent Blindness Career Development Award (PH), MEEI Foundation, Falk Medial Research Trust
Sponsor: Pedram Hamrah, MD, FACS
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2015
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