Dynamic Observation Of The Corneal Herpetic Endotheliitis After Drug Treatment

Objective:To demonstrate the features and the outcomes of the corneal epithelial cells, stroma cells,endothelium cells, dendritic cells and Inflammatory cells after treatment of corneal herpetic endotheliitis by in vivo confocal mircroscopy combined with Anterior Segment OCT. The treatment was adjusted according to the examination.Methods:Thirty patients (30 eyes) with corneal herpetic endotheliitis were referred to our institution. Twenty-one were male and nine female, with an age range of 17 to 69 years, the average were 55 years old. An average history of 20 days, from 1 week to 2 months.6 patients was fan endotheliitis,4 of them had a history of recurrent episodes of corneal disease.17 patients was disciform endotheliitis,8 of them had a history of recurrent episodes,3 patients were associated with secondary glaucoma,2 patients were associated with hypopyon.7 patients was diffuse endotheliitis,4 of them with a history of recurrent episodes. All patients were given systemic and topical antiviral medications combined with corticosteroids, intraocular pressure were applied antiglaucoma medication. Corneal edema, endothelial surface and the changes of KP were recorded by Slit lamp microscope. All patients were examined by confocal mircroscopy,to analyse the quantity and morphological changes of corneal epithelial cells, stroma cells,endothelium cells, dendritic cells and Inflammatory cellsjust before treatment and 7-14 days and 1,3 month after the treatment.. Anterior segment OCT showed the the morphological changes of cornea.The treatment was adjusted according to the examination Results:Slit lamp microscope examination show that fan endotheliitis and diffuse endotheliitis recovered rapidly,the corneal edema subsided after 7 days of treatment. After 2 weeks of continuous therapy, Cornea became transparent, KP significantly reduced or dissipated.For the secondary glaucoma patients, intraocular pressure was reduced to normal range within 7 days.Empyema disappeared 3-5 days after the treatment.For the patients was diffuse endotheliitis, the corneal edema subsided after 10-14 days of treatment, after 20-30 days of continuous therapy, the cornea became transparent, KP significantly reduced or dissipated. during the follow-up period, there was no relapse of HSK. Confocal microscope images revealed that epithelium cells were large in size and lose distinct boundaries, smaller, highly-reflective inflammatory cell infiltration. 7-14 days after the treatment, normal epithelium cells could be detected, inflammatory cells were significantly decreased or disappeared. Dendritic cells measuring up to 44μm and extending form the epithelial layers through the Bowman's zone to the Superficial stroma. Highly reflective DCs presenting typical branching dendrites and the migration of DCs can be observed. Around the transparent area, A larger number of DCs with thin cell bodies and dendrites are imaged. The density of DCs reduced gradually, the DCs with intermediate reflectivity and small dendritic processes. The density of DC cells were:(137±46), (148±33), (100±25), (53±15) cells/mm2, the contralateral healthy eye was 29±5 cells/mm2. DCs density was found to be significantly higher in the HSK eye in comparison to contralateral healthy eye. Keratocytes were altered in appearance with increased visibility of the cytoplasm, normal keratocytes could be detected gradually one month after the treatment.No structure status could be detected.Before treatment, the endothelial cells coud not be visualized with confocal microscopy. In the transparent area, endothelial cells were activated, the nucleus can be seen.7 or 14 days after treatment, confocal microscopy examination revealed that: cellular edema, infiltration of inflammatory cells into the endothelial layer, loss of defined cell boundaries,nucleus was visible and high-reflective,endothelial denudation, which are considered characteristic of endothelial involvement in human HSV endotheliitis.1 month after treatment, Inflammatory cells and the proportion of irregular hexagonal cells reduced, guttata was Visible. After 3 months of treatment, normal endothelial cells which had hexagonal structure could be seen,but a few guttata and KP still could be found in some patients. Corticosteroids was tapered gradually if little DCs and no inflammatory cells were detected by confocal microscopy.Corneal endothelial cell density was 2009.3±200个/ mm2, the contralateral healthy eye 2456.00±382个/mm2, the difference was statistically significant.Measured with AS-OCT, the corneal thickness increased significantly, was:686.31±67.54μm,highly reflective KP and folds were visible. After 7-14 days of treatment,the corneal thickness decreased,was 516.69±59.58μm. KP in the endothelial layer disappeared or become smaller.1 month after treatment, the corneal thickness was normal and no KP could be found.Some patients had high density of strong reflection zone in the superficial stroma.Conclusions:In vivo confocal mircroscopy and AS-OCT can provide us with detailed histopathology proofs and appear dynamically the transformation after treatment of corneal herpetic endotheliitis. It plays an important role in improving the diagnostic level and directing the medication in our clinical practicing works.