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Monitoring the inflammatory process in herpetic stromal keratitis: the role of in vivo confocal microscopy.
Ophthalmology 2012; 119(6):1102-10O

Abstract

PURPOSE

To investigate the role of in vivo confocal microscopy (IVCM) in the detection of inflammatory activity and follow-up of herpetic stromal keratitis (HSK).

DESIGN

Prospective observational cohort study.

PARTICIPANTS

Thirty-eight patients with active HSK.

METHODS

Within 7 days after diagnosis of active HSK, both eyes of each patient were examined by slit-lamp biomicroscopy and white-light IVCM (Confoscan 4; Nidek Technologies, Padova, Italy). The HSK-affected eyes were followed up at 1, 3, 6, and 12 months, whereas the unaffected fellow eyes were reexamined after 12 months. Three patients did not complete follow-up and were excluded for data analyses. All IVCM examinations were assessed for morphologic alterations characteristic of inflammatory activity and for corneal backscatter. As secondary outcome parameters, best-corrected visual activity (BCVA), central corneal thickness (CCT), intraocular pressure (IOP), and endothelial cell density (ECD) were determined at each study visit. We used repeated-measures analysis of variance to assess changes during the 12-month follow-up period and paired t tests to compare HSK-affected eyes with fellow eyes.

MAIN OUTCOME MEASURES

Presence of dendriform cells, pseudoguttae, and keratic precipitates, and follow-up of mean corneal backscatter.

RESULTS

An increase of dendriform cells and pseudoguttae often accompanied stromal infiltration. Because these IVCM parameters were indiscernible or overlooked at slit-lamp examination, they proved to be excellent indicators of inflammatory activity. At 12 months' follow-up, mean corneal backscatter had decreased significantly by 36%, but still fell outside the normal range in 24 (69%) of the HSK-affected eyes. By using slit-lamp in conjunction with IVCM, we detected 17 recurrences in 14 of 35 patients (40%). Three of these recurrences were missed by slit-lamp, and 6 of these were missed by IVCM. At 12 months' follow-up, BCVA (-9 letters), CCT (-36 μm), and ECD (-313 cells/mm(2)) were significantly lower, whereas IOP (1.8 mmHg) was significantly higher, in HSK-affected eyes compared with fellow eyes.

CONCLUSIONS

The data presented demonstrate that IVCM is complementary to slit-lamp examination in the follow-up of HSK, particularly because of its power to detect early signs of intracorneal inflammatory activity. Therapy guidance based on morphologic assessment and corneal backscatter measurement by combined IVCM and slit-lamp examination may improve the outcome of HSK.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Authors+Show Affiliations

Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands. t.hillenaar@oogziekenhuis.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22361312

Citation

Hillenaar, Toine, et al. "Monitoring the Inflammatory Process in Herpetic Stromal Keratitis: the Role of in Vivo Confocal Microscopy." Ophthalmology, vol. 119, no. 6, 2012, pp. 1102-10.
Hillenaar T, van Cleynenbreugel H, Verjans GM, et al. Monitoring the inflammatory process in herpetic stromal keratitis: the role of in vivo confocal microscopy. Ophthalmology. 2012;119(6):1102-10.
Hillenaar, T., van Cleynenbreugel, H., Verjans, G. M., Wubbels, R. J., & Remeijer, L. (2012). Monitoring the inflammatory process in herpetic stromal keratitis: the role of in vivo confocal microscopy. Ophthalmology, 119(6), pp. 1102-10. doi:10.1016/j.ophtha.2011.12.002.
Hillenaar T, et al. Monitoring the Inflammatory Process in Herpetic Stromal Keratitis: the Role of in Vivo Confocal Microscopy. Ophthalmology. 2012;119(6):1102-10. PubMed PMID: 22361312.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monitoring the inflammatory process in herpetic stromal keratitis: the role of in vivo confocal microscopy. AU - Hillenaar,Toine, AU - van Cleynenbreugel,Hugo, AU - Verjans,Georges M G M, AU - Wubbels,René J, AU - Remeijer,Lies, Y1 - 2012/02/22/ PY - 2011/08/04/received PY - 2011/10/10/revised PY - 2011/12/02/accepted PY - 2012/2/25/entrez PY - 2012/3/1/pubmed PY - 2012/8/23/medline SP - 1102 EP - 10 JF - Ophthalmology JO - Ophthalmology VL - 119 IS - 6 N2 - PURPOSE: To investigate the role of in vivo confocal microscopy (IVCM) in the detection of inflammatory activity and follow-up of herpetic stromal keratitis (HSK). DESIGN: Prospective observational cohort study. PARTICIPANTS: Thirty-eight patients with active HSK. METHODS: Within 7 days after diagnosis of active HSK, both eyes of each patient were examined by slit-lamp biomicroscopy and white-light IVCM (Confoscan 4; Nidek Technologies, Padova, Italy). The HSK-affected eyes were followed up at 1, 3, 6, and 12 months, whereas the unaffected fellow eyes were reexamined after 12 months. Three patients did not complete follow-up and were excluded for data analyses. All IVCM examinations were assessed for morphologic alterations characteristic of inflammatory activity and for corneal backscatter. As secondary outcome parameters, best-corrected visual activity (BCVA), central corneal thickness (CCT), intraocular pressure (IOP), and endothelial cell density (ECD) were determined at each study visit. We used repeated-measures analysis of variance to assess changes during the 12-month follow-up period and paired t tests to compare HSK-affected eyes with fellow eyes. MAIN OUTCOME MEASURES: Presence of dendriform cells, pseudoguttae, and keratic precipitates, and follow-up of mean corneal backscatter. RESULTS: An increase of dendriform cells and pseudoguttae often accompanied stromal infiltration. Because these IVCM parameters were indiscernible or overlooked at slit-lamp examination, they proved to be excellent indicators of inflammatory activity. At 12 months' follow-up, mean corneal backscatter had decreased significantly by 36%, but still fell outside the normal range in 24 (69%) of the HSK-affected eyes. By using slit-lamp in conjunction with IVCM, we detected 17 recurrences in 14 of 35 patients (40%). Three of these recurrences were missed by slit-lamp, and 6 of these were missed by IVCM. At 12 months' follow-up, BCVA (-9 letters), CCT (-36 μm), and ECD (-313 cells/mm(2)) were significantly lower, whereas IOP (1.8 mmHg) was significantly higher, in HSK-affected eyes compared with fellow eyes. CONCLUSIONS: The data presented demonstrate that IVCM is complementary to slit-lamp examination in the follow-up of HSK, particularly because of its power to detect early signs of intracorneal inflammatory activity. Therapy guidance based on morphologic assessment and corneal backscatter measurement by combined IVCM and slit-lamp examination may improve the outcome of HSK. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/22361312/Monitoring_the_inflammatory_process_in_herpetic_stromal_keratitis:_the_role_of_in_vivo_confocal_microscopy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(11)01146-8 DB - PRIME DP - Unbound Medicine ER -