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Li A, Soifer M, Cox AR, Debiec M, Matsyaraja T, Khanna S, Kodati S. Herpes Zoster Chorioretinopathy: A Case Series. Ocul Immunol Inflamm 2024:1-7. [PMID: 38639557 DOI: 10.1080/09273948.2024.2338271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To report two patients with herpetic zoster panuveitis and chorioretinopathy with choroidal hypopigmentation. METHODS Retrospective chart review of two patients. RESULTS We report a series of two patients with a history of HZO with orbital inflammation and panuveitis, who developed patchy choroidal depigmentation consistent with a choroidopathy. The lesions were extensive and involved the posterior pole and mid-periphery in both cases. Both cases demonstrated scattered areas of ellipsoid zone loss, and fluorescein angiography showed corresponding late hyperfluorescence. OCTA in one case demonstrated flow voids at the level of choriocapillaris. CONCLUSIONS Our series suggests that herpetic chorioretinopathy may be a relatively benign process that presents late and may involve large areas of the posterior choroid.
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Affiliation(s)
- Ashley Li
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Matias Soifer
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anthony R Cox
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Matthew Debiec
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tejaswini Matsyaraja
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Sangeeta Khanna
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
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2
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Abazari A, Abbouda A, Cruzat A, Cavalcanti B, Pavan-Langston D, Hamrah P. Corneal reinnervation in patients with severe neurotrophic keratopathy secondary to herpes zoster ophthalmicus after treatment with autologous serum tear drops. CORNEA OPEN 2024; 3:e0029. [PMID: 39145285 PMCID: PMC11323069 DOI: 10.1097/coa.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Purpose To study potential corneal reinnervation and recovery of corneal sensation in patients with severe neurotrophic keratopathy (NK) secondary to herpes zoster ophthalmicus (HZO) after treatment with topical autologous serum tears (AST). Method Four cases of HZO with severe NK were followed clinically and by serial laser in vivo confocal microscopy (IVCM, HRT3/RCM, Heidelberg Engineering) before and during treatment with 20% AST drops eight times a day. Two masked observers reviewed the IVCM images and assessed corneal nerve alterations. Results At baseline, all patients had complete loss of corneal sensation. In addition, IVCM showed complete lack of the subbasal corneal nerve plexus in all patients. All four patients were refractory to conventional therapies and were treated with AST drops. All patients demonstrated significant nerve regeneration by IVCM within 3-7 months of treatment. The total nerve density increased to a mean ± SEM of 10,085.88±2,542.74 μm/mm2 at the last follow up. Corneal sensation measured by Cochet-Bonnet esthesiometry improved to a mean ± SEM of 3.50±1.30 cm. Interestingly, 3 of 4 patients developed stromal keratitis with ulceration within weeks of corneal reinnervation, which was reversed by adding topical steroids. Conclusion Autologous serum tears are effective in restoring corneal subbasal nerves and sensation in patients with severe NK secondary to HZO. However, this group of patients may require concurrent topical immunomodulation and antiviral therapy while on AST to prevent stromal keratitis.
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Affiliation(s)
- Azin Abazari
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Alessandro Abbouda
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Andrea Cruzat
- Cornea Service & Ocular Surface Imaging Center, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Bernardo Cavalcanti
- Cornea Service & Ocular Surface Imaging Center, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Deborah Pavan-Langston
- Cornea Service & Ocular Surface Imaging Center, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Pedram Hamrah
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
- Cornea Service & Ocular Surface Imaging Center, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA
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Mok E, Kam KW, Young AL. Corneal nerve changes in herpes zoster ophthalmicus: a prospective longitudinal in vivo confocal microscopy study. Eye (Lond) 2023; 37:3033-3040. [PMID: 36906697 PMCID: PMC10008015 DOI: 10.1038/s41433-023-02469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023] Open
Abstract
PURPOSE To study the changes in corneal nerves and corneal sensitivity over a 6-month period in patients with herpes zoster ophthalmicus (HZO) compared with healthy subjects. METHODS This was a prospective longitudinal study on patients with newly diagnosed HZO. In vivo confocal microscopy (IVCM) corneal nerve parameters and corneal sensitivity were measured and compared between eyes with HZO, contralateral eyes and controls at baseline, 2 and 6 months. RESULTS Fifteen subjects with HZO and 15 healthy age and sex matched controls were recruited. HZO eyes revealed a reduction in corneal nerve branch density (CNBD) from baseline to 2 months (9.65 ± 5.75 vs. 5.90 ± 6.87/mm2, p = 0.018), and decreased corneal nerve fibre density (CNFD) at 2 months when compared with control (p = 0.025). However, these differences resolved by 6 months. HZO fellow eyes demonstrated increased corneal nerve fibre area (CNFA), corneal nerve fibre width (CNFW) and corneal nerve fractal dimension (CNFrD) at 2 months compared with baseline (p = 0.025, 0.031, 0.009). There was no change in corneal sensitivity for both HZO affected and HZO fellow eyes from baseline or over time, nor was it different from sensitivity in controls. CONCLUSION Corneal denervation was present at 2 months in HZO eyes, with an observed recovery by 6 months. HZO fellow eyes demonstrated increased corneal nerve parameters at 2 months, which could represent a proliferative response to nerve degeneration. IVCM is useful in monitoring corneal nerve changes, and is more sensitive in detecting nerve alterations than esthesiometry.
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Affiliation(s)
- Eugenie Mok
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong.
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Cheung AY, Holland EJ, Lee WB, Beckman KA, Tu E, Farid M, Pepose J, Gupta PK, Fram N, Mah F, Mannis MJ. Neurotrophic keratopathy: An updated understanding. Ocul Surf 2023; 30:129-138. [PMID: 37666470 DOI: 10.1016/j.jtos.2023.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/10/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To propose an updated definition and staging system for neurotrophic keratopathy (NK) and provide consensus on diagnosis and treatment. METHODS A study group was convened to review the data pertinent to NK using a modified nominal group process. They proposed an updated definition for NK and a new 6-step staging system (Neurotrophic Keratopathy Study Group [NKSG] Classification) that can be used in conjunction with the different treatment options available currently or in the future. RESULTS NK is defined as the dysfunction of corneal innervation that results in dysregulation of corneal and/or cellular function. It is characterized by loss of corneal sensation and neuronal homeostasis, leading to eventual corneal epithelial breakdown and ultimately keratolysis if untreated. The NKSG classification emphasizes verifying corneal sensation early and distinguishes different epithelial and stromal aspects of NK with the following stages: stage 1 (altered sensation without keratopathy), stage 2 (epitheliopathy/punctate epithelial keratopathy [PEK] without stromal haze), stage 3 (persistent/recurrent epithelial defects without stromal haze), stage 4 (epitheliopathy/PEK or persistent/recurrent epithelial defects with stromal haze), stage 5 (persistent/recurrent epithelial defect with corneal ulceration), and stage 6 (corneal perforation). Treatment consists of a variety of modalities (both indirect and direct). CONCLUSIONS This updated definition and staging system will provide clinicians with the necessary information to diagnose and treat NK at an early stage before it becomes a sight-threatening disorder. It also provides a framework for evaluating current and future treatment options at distinct stages of the disease.
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Ma Y, Tian Y, Chen X, Agrawal R, Feng Y. Bilateral Pupillary Involvement as a Clinical Presentation of Herpes Zoster Ophthalmicus. Ocul Immunol Inflamm 2023; 31:87-91. [PMID: 34637674 DOI: 10.1080/09273948.2021.1986075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Herpes zoster ophthalmicus (HZO) is traditionally considered as an unilateral disease. However, subclinical involvements in the contralateral eye structures are evidence, giving rise to a broader understanding of varicella-zoster virus (VZV) infection. METHODS We enrolled 20 eyes of 10 patients with HZO and 12 eyes of healthy controls to investigate the bilateral features of HZO patients using a hand-held pupillometer and a Cochet-Bonnet esthesiometer. RESULTS Maximum pupil size before constriction (INT) and minimum diameter when pupil constricts at peak (END) were significantly smaller in patients affected eyes compared with those in controls (p < .05). Interestingly, INT and END were significantly reduced in contralateral eyes of 20 affected patients and also in comparison to control group (p < .001 and p = .034 respectively). CONCLUSION The contralateral eyes may have subclinical involvement in patients with HZO based on significantly abnormal pupillary light reflex (PLR). Pupillometer provides a primary and convenient method to investigate the anatomy and pathology of the PLR.
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Affiliation(s)
- Yan Ma
- Department of Neurology, Peking University Third Hospital, Bejing, China
| | | | - Xia Chen
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yun Feng
- Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Bejing, China
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Rathi A, Bothra N, Priyadarshini SR, Achanta DSR, Fernandes M, Murthy SI, Kapoor AG, Dave TV, Rath S, Yellinedi R, Nuvvula R, Dendukuri G, Naik MN, Ramappa M. Neurotization of the human cornea - A comprehensive review and an interim report. Indian J Ophthalmol 2022; 70:1905-1917. [PMID: 35647955 PMCID: PMC9359267 DOI: 10.4103/ijo.ijo_2030_21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present a comprehensive review of existing literature on surgical corneal neurotization (SCN) as a treatment modality for neurotrophic keratopathy (NK) with an interim report of seven cases where SCN was performed using the indirect approach and followed up till 18 months postoperatively to look for improvement in ocular surface, corneal sensations, and nerve regeneration by using in vivo confocal microscopy (IVCM). A literature search was performed for publications with keywords “corneal nerves,” “neurotization,” “esthesiometry,” “corneal anesthesia,” and “neurotrophic keratopathy.” All literature available till December 31, 2020 was reviewed and included to describe NK and its management options, particularly SCN. NK is associated with absent or reduced corneal sensations and is managed using a step-ladder algorithm ranging from medical management for symptomatic relief to surgical corneal neurotization. Both direct and indirect approaches of SCN have a favorable outcome with reduced surgical morbidity in the indirect approach using sural nerve graft. Post neurotization, corneal sensation recovery may take up to 3–6 months, while nerve regeneration on confocal microscopy can take as long as 6 months–1 year.
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Affiliation(s)
- Anubha Rathi
- The Cornea Institute, KAR Campus; Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nandini Bothra
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute; Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Divya S R Achanta
- The Cornea Institute, KAR Campus; Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Merle Fernandes
- The Cornea Institute, KAR Campus, Hyderabad, Telangana; The Cornea Institute, GMRV Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | | | - Anasua G Kapoor
- Ophthalmic Plastic Surgery and Aesthetics, Ocular Oncology, KVC Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Tarjani V Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Suryasnata Rath
- Ophthalmic Plastic Surgery and Aesthetics, Ocular Oncology, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Rajesh Yellinedi
- Basavatarakam, Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rambabu Nuvvula
- Basavatarakam, Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Gautam Dendukuri
- Ophthalmic Plastic Surgery, Aesthetics and Faciomaxillary Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Milind N Naik
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Muralidhar Ramappa
- The Cornea Institute, KAR Campus; Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute; Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
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7
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Kim JS, Rafailov L, Leyngold IM. Corneal Neurotization for Postherpetic Neurotrophic Keratopathy: Initial Experience and Clinical Outcomes. Ophthalmic Plast Reconstr Surg 2021; 37:42-50. [PMID: 32332687 DOI: 10.1097/iop.0000000000001676] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess early outcomes of corneal neurotization for postherpetic neurotrophic keratopathy (NK). METHODS Retrospective analysis of patients who underwent corneal neurotization for postherpetic NK by a single experienced oculoplastic surgeon was performed. Collected data included stage and etiology of NK as well as comorbidities, prior treatment history, neurotization technique, donor nerve site, preoperative and postoperative examination findings (i.e., ocular surface quality, corneal clarity, corneal sensation by Cochet-Bonnet esthesiometry, and visual acuity [VA]), and follow-up duration. Differences between preoperative and postoperative values were analyzed by Wilcoxon signed-rank test. RESULTS Of 23 adult patients who underwent corneal neurotization, 3 (13%) had history of herpes simplex keratitis and/or endotheliitis, and 4 (17%) had history of herpes zoster ophthalmicus. One patient with herpes zoster ophthalmicus was excluded due to inadequate follow-up duration. Of the 6 patients included in the study, 3 (50%) had Mackie stage 1 disease, 1 (17%) had stage 2, and 2 (33%) had stage 3 with impending perforation, but all had markedly diminished corneal sensation, with a median denervation time of 11.8 months (interquartile range [IQR] 9.4-29.2 months). Following neurotization, median corneal sensation improved significantly from 1.6 cm (interquartile range 0.0-1.9 cm) to 3.6 cm (IQR 3.0-5.6 cm, p = 0.028), with 1 patient achieving full sensation by postoperative month 5. All patients with a persistent epithelial defect preoperatively showed complete corneal healing by their last follow-up visit. VA also improved postoperatively in all patients (p = 0.028). Median follow-up duration was 11.3 months (interquartile range 9.6-17.9 months). CONCLUSIONS Corneal neurotization can successfully reinnervate corneas previously devitalized by herpetic disease and halt the progressive nature of postherpetic NK. If utilized appropriately and early in the disease process, neurotization may reduce morbidity and maximize visual potential in postherpetic NK.
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Affiliation(s)
- Jane S Kim
- Department of Ophthalmology, Duke University, Durham, North Carolina, U.S.A
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8
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Corneal nerves in health and disease. Prog Retin Eye Res 2019; 73:100762. [DOI: 10.1016/j.preteyeres.2019.05.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 12/15/2022]
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Abstract
PURPOSE OF REVIEW Neurotrophic keratopathy is a devastating corneal condition that can lead to ocular morbidity and blindness. Current medical and surgical treatments poorly tackle the essential problem of corneal aesthesia and hence fail to provide a permanent cure. Recent advances in corneal neurotization techniques have shown promise to restore corneal nerves in neurotrophic keratopathy. This article aims at reviewing the current surgical advances, along with the current thoughts and evidence available for corneal nerve regeneration. RECENT FINDINGS Corneal neurotization was first introduced in 2009 by Terzis et al., but recently picked up more interest since 2014. Direct and indirect neurotization are being developed, and different nerves (sural nerve, great auricular nerve) have been explored for interposition between frontal nerve branches and the cornea. New endoscopic techniques are introduced for less invasive approaches. On the corneal front, confocal microscopy and esthesiometry studies have established that the regeneration of the corneal nerves is happening 6 months after the procedure. SUMMARY Neurotization is a budding revolutionary technique that shows promise of cure for neurotrophic corneas, but at this stage, it is still reasonably invasive and still reserved for selected patients.
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10
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McKay TB, Seyed-Razavi Y, Ghezzi CE, Dieckmann G, Nieland TJF, Cairns DM, Pollard RE, Hamrah P, Kaplan DL. Corneal pain and experimental model development. Prog Retin Eye Res 2019; 71:88-113. [PMID: 30453079 PMCID: PMC6690397 DOI: 10.1016/j.preteyeres.2018.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 12/13/2022]
Abstract
The cornea is a valuable tissue for studying peripheral sensory nerve structure and regeneration due to its avascularity, transparency, and dense innervation. Somatosensory innervation of the cornea serves to identify changes in environmental stimuli at the ocular surface, thereby promoting barrier function to protect the eye against injury or infection. Due to regulatory demands to screen ocular safety of potential chemical exposure, a need remains to develop functional human tissue models to predict ocular damage and pain using in vitro-based systems to increase throughput and minimize animal use. In this review, we summarize the anatomical and functional roles of corneal innervation in propagation of sensory input, corneal neuropathies associated with pain, and the status of current in vivo and in vitro models. Emphasis is placed on tissue engineering approaches to study the human corneal pain response in vitro with integration of proper cell types, controlled microenvironment, and high-throughput readouts to predict pain induction. Further developments in this field will aid in defining molecular signatures to distinguish acute and chronic pain triggers based on the immune response and epithelial, stromal, and neuronal interactions that occur at the ocular surface that lead to functional outcomes in the brain depending on severity and persistence of the stimulus.
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Affiliation(s)
- Tina B McKay
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA, 02155, USA
| | - Yashar Seyed-Razavi
- Center for Translational Ocular Immunology and Cornea Service, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Chiara E Ghezzi
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA, 02155, USA
| | - Gabriela Dieckmann
- Center for Translational Ocular Immunology and Cornea Service, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas J F Nieland
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA, 02155, USA
| | - Dana M Cairns
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA, 02155, USA
| | - Rachel E Pollard
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA, 02155, USA
| | - Pedram Hamrah
- Center for Translational Ocular Immunology and Cornea Service, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, 4 Colby Street, Medford, MA, 02155, USA.
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Corneal Sub-Basal Nerve Changes in Patients with Herpetic Keratitis During Acute Phase and after 6 Months. ACTA ACUST UNITED AC 2019; 55:medicina55050214. [PMID: 31137905 PMCID: PMC6572578 DOI: 10.3390/medicina55050214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: The purpose of this study was to describe corneal sensitivity and the morphological changes of sub-basal corneal nerves using in vivo laser scanning confocal microscopy (LSCM) in herpes simplex virus (HSV) keratitis-affected eyes, and to compare with both contralateral eyes and with the eyes of patients with a previous history of herpes labialis but no history of herpetic eye disease, and with healthy patients with no history of any HSV diseases, during the acute phase of the disease and after six months. Materials and Methods: A prospective clinical study included 269 patients. All of them underwent a complete ophthalmological examination, Cochet-Bonnet aesthesiometry and LSCM within the central 5 mm of the cornea. After six months, all the patients with herpetic eye disease underwent the same examination. Serology tests of the serum to detect HSV 1/2 IgG and IgM were performed. Results: HSV-affected eyes compared with contralateral eyes, herpes labialis and healthy control group eyes demonstrated a significant decrease in corneal sensitivity, corneal nerve fibre density, corneal nerve branch density, corneal nerve fibre length and corneal nerve total branch density (p < 0.05). During follow up after six months, corneal sensitivity and sub-basal nerve parameters had increased but did not reach the parameters of contralateral eyes (p < 0.05). Previous herpes labialis did not influence corneal sensitivity and was not a risk factor for herpetic eye disease. Conclusions: Corneal sensitivity and sub-basal nerve changes in HSV-affected eyes revealed a significant decrease compared with contralateral eyes, and with the eyes of patients with a previous history of herpes labialis, and of healthy controls. Following six months, corneal sensitivity and sub-basal nerve parameters increased; however, they did not reach the parameters of contralateral eyes and the eyes of healthy controls. The best recovery of corneal sensitivity was seen in patients with epithelial keratitis. Herpes labialis was not a risk factor for herpetic eye disease.
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12
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Zemaitiene R, Rakauskiene M, Danileviciene V, Use V, Kriauciuniene L, Zaliuniene D. Corneal esthesiometry and sub-basal nerves morphological changes in herpes simplex virus keratitis/uveitis patients. Int J Ophthalmol 2019; 12:407-411. [PMID: 30918808 DOI: 10.18240/ijo.2019.03.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/28/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To describe and compare corneal sensation and morphological changes of sub-basal corneal nerves by in vivo laser scanning confocal microscopy (LSCM) in herpes simplex virus (HSV) keratitis/uveitis and contralateral, clinically unaffected eyes. METHODS A prospective clinical study included 30 HSV eyes and 30 contralateral eyes of 30 patients, diagnosed with unilateral HSV keratitis/uveitis. Both eyes underwent a complete ophthalmological examination, Cochet-Bonnet aesthesiometry and LSCM of the central cornea, using the Heidelberg Retina Tomograph III Rostock Cornea Module. After 6mo, the same examination of the HSV affected and contralateral, clinically unaffected eyes was performed. RESULTS HSV eyes, as compared to contralateral eyes, demonstrated a significant decrease in mean corneal sensation (3.1±1.6 vs 5.3±0.8 cm), total nerve fibres number (5.7±4.4 vs 15.1±5.4), nerve branches (3.4±3.0 vs 8.4±4.7), main nerve trunks (2.3±1.6 vs 5.8±2.2), and nerve fibres density (7.5±5.6 vs 18.1±5.3 mm/mm2, P<0.05). There was no significant difference between keratitis and uveitis eyes in mean corneal sensation and nerve fibres parameters. After 6mo, corneal sensation and sub-basal nerve fibres parameters were increased significantly, but did not reach the parameters of contralateral, clinically unaffected eyes. CONCLUSION Corneal aesthesiometry and LSCM in HSV affected eyes reveals a significant decrease of corneal sensation and sub-basal nerve fibres which recovers at 6mo but does not reach the normal level.
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Affiliation(s)
- Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Modesta Rakauskiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Viliija Danileviciene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Violeta Use
- Department of Langueges and Educology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Loresa Kriauciuniene
- Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
| | - Dalia Zaliuniene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania
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13
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Efficacy of autologous serum tears for treatment of neuropathic corneal pain. Ocul Surf 2019; 17:532-539. [PMID: 30685437 DOI: 10.1016/j.jtos.2019.01.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Corneal nerve damage may result in neuropathic corneal pain (NCP). Autologous serum tears (AST) have been shown to results in nerve regeneration and may help alleviate corneal pain. This study aimed to evaluate the efficacy of AST in the treatment of NCP. METHODS This was a retrospective case-control study. Sixteen patients suffering from severe NCP and no current ocular surface disease were compared to 12 controls. In vivo confocal microscopy (IVCM) (HRT3/RCM; Heidelberg Engineering GmbH, Germany) of the central corneas was performed bilaterally. Change in pain severity (scale of 0-10), corneal nerve density, tortuosity, reflectivity and presence of beading and micro-neuromas before and after treatment were recorded. RESULTS All patients had severe pain, with a mean of 9.1 ± 0.2 (range 8-10). Subbasal nerves were significantly decreased before treatment as compared to controls, including total nerve length (10,935.5 ± 1264.3 vs. 24,714.4 ± 1056.2 μm/mm2; p < 0.0001) and total number of nerves (10.5 ± 1.4 vs. 28.6 ± 2.0; p < 0.0001), respectively. Morphologically, significantly increased reflectivity (2.9 ± 0.2 vs. 1.2 ± 0.1; p = 0.00008) and tortuosity (2.4 ± 0.2 vs. 1.7 ± 0.1; p = 0.001), both graded on a scale of 0-4, were noted. After a mean of 3.8 ± 0.5 months (range 1-8 months) of AST treatment, pain severity decreased to 3.1 ± 0.3 (range 0-4), (p < 0.0001). Further, IVCM demonstrated a significant improvement (p < 0.005) in total nerve length (17,351.3 ± 1395.6 μm/mm2) and number (15.1 ± 1.6), as well as significant decrease in reflectivity (2.4 ± 0.2; p = 0.001) and tortuosity (2.2 ± 0.2; p = 0.001). CONCLUSION IVCM demonstrates underlying alterations of the subbasal corneal nerve plexus in patients suffering from debilitating NCP. AST-induced nerve regeneration is seen following treatment with AST, which correlates with improvement in patient symptoms of NCP.
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Harris DL, Yamaguchi T, Hamrah P. A Novel Murine Model of Radiation Keratopathy. Invest Ophthalmol Vis Sci 2018; 59:3889-3896. [PMID: 30073349 PMCID: PMC6071476 DOI: 10.1167/iovs.18-24567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose Radiation therapy results in severe chronic keratopathy and dry eye disease. We developed a novel mouse model for radiation keratopathy to allow future mechanistic studies. Methods Six to 8-week-old BALB/c mice underwent sublethal irradiation to the head only from a Cesium-137 irradiator, 2 × 550 rad, 3-hours apart. Irradiated mice were clinically evaluated by corneal fluorescein staining (CFS) at 1, 2, and 3 months, after which corneas were excised and immunofluorescence histochemistry performed with anti-CD45, anti-MHC class II, and anti-β-tubulin antibodies. Results The survival rate after irradiation was 100%. Mice demonstrated significant CFS and hair loss around the eyes. Corneal nerve density decreased in the central and peripheral corneas (P < 0.01) at 2 and 3 months, respectively. CD45+ immune cell densities increased in the central and peripheral corneas (P < 0.005, P < 0.001) at 2 and 3 months, respectively. MHC class II, a sign of antigen presenting cell activation, significantly increased after irradiation in the central and peripheral corneas at 2 and 3 months (P = 0.02). A strong inverse correlation was noted between decreased corneal nerves and increase in CD45+ cells in the central cornea at 2 (P = 0.04, r = -0.89) and 3 months (P = 0.03, r = -0.91) after irradiation. Conclusions We present a model of radiation keratopathy and demonstrate significant nerve loss and increase in immune cell influx and activation within months. This model will enable future investigations to understand the effects of radiation therapy on the eye, and to study mechanisms of neuro-immune crosstalk in the cornea.
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Affiliation(s)
- Deshea L. Harris
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
- Immune Disease Institute, Program in Cellular and Molecular Medicine at Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Takefumi Yamaguchi
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
- Immune Disease Institute, Program in Cellular and Molecular Medicine at Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States
- Department of Ophthalmology, Tokyo Dental College, Chiba, Japan
| | - Pedram Hamrah
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
- Immune Disease Institute, Program in Cellular and Molecular Medicine at Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
- Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
- Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center Tufts University School of Medicine, Boston, Massachusetts, United States
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Management of chronic complications associated with herpes zoster ophthalmicus. Curr Opin Ophthalmol 2018; 29:334-339. [DOI: 10.1097/icu.0000000000000492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effects of ambient humidity on the Cochet-Bonnet aesthesiometer. Eye (Lond) 2018; 32:1644-1651. [PMID: 29921953 DOI: 10.1038/s41433-018-0150-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/11/2018] [Accepted: 05/16/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The Cochet-Bonnet (COBO) aesthesiometer is the current standard in corneal sensitivity assessment. This study investigates the influence of ambient room humidity levels on the stimulus force exerted by the instrument. METHODS A COBO instrument (Luneau Opthalmologie) with 0.12 mm nominal nylon filament diameter was placed in an environment chamber (Electro-tech systems Inc. PA, USA) at 25 °C and relative humidity (%RH) set to either 20-80%, in 10% steps. After 12 h in the chamber at a chosen %RH level, the instrument was removed and exerted force measured by pressing the nylon filament onto the plate of an analytical microbalance (Mettler-Toledo AB265; precision ±0.0001 g) at a perpendicular angle, by a predetermined amount. Exerted force onto the microbalance was recorded in grams for a specified filament length. Procedure was repeated for filament lengths 10-60 mm, in 5 mm steps. The instrument was returned to the chamber and procedure repeated 5 times, before repeating at the next %RH setting (random order). Measurements at each filament lengths were compared using one-way ANOVA and post-hoc Tukey's range test. A p-value < 0.05 denoted statistical significance. RESULTS Significant differences in exerted force were observed with alteration in %RH levels for each filament length (all p < 0.001). Exerted force decreased significantly with an increase in %RH for all filament lengths, with the average force decreasing by 15% with each 10% rise in %RH. CONCLUSIONS This study confirms previous suggestions that the rigidity of the COBO nylon filament is affected by ambient room humidity levels, with implications on the stimulus force delivered by the instrument. A conversion table is provided for converting filament lengths to pressure for a range of relative humidity levels.
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Kokot J, Wylęgała A, Wowra B, Wójcik Ł, Dobrowolski D, Wylęgała E. Corneal confocal sub-basal nerve plexus evaluation: a review. Acta Ophthalmol 2018; 96:232-242. [PMID: 28741902 DOI: 10.1111/aos.13518] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 06/01/2017] [Indexed: 12/12/2022]
Abstract
The aim of this study was to review the most recent data about corneal sub-basal nerve plexus (SNP) evaluated with the use of corneal confocal microscopy (CCM). For this purpose, an electronic search was conducted based on PubMed and Google Scholar and Web of Science databases from 2008 up to the end of 2016. Ninety-eight articles in English were cited, as well as abstracts in other languages, concerning the morphology and function of corneal SNP in various diseases. Changes in corneal SNP as a result of local treatment were also introduced. Figures with scans from confocal microscopy from our Department were included. The main conclusion of this review was that both corneal SNP diminishment and high tortuosity as well as low sensitivity are in principle related to the presence or level of pathology. In addition, increased nerve tortuosity may represent a morphological determinant of nerve regeneration. However, the presented literature shows that SNP changes are not characteristic for one unified corneal pathology; rather, they reflect the non-specific pathological process present in many diseases. Future studies should use automatized biometric software and also examine the effects of new treatments on SNP.
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Affiliation(s)
- Joanna Kokot
- Ophthalmology Department; Railway Hospital Katowice; II School of Medicine with the Division of Dentistry in Zabrze; Medical University of Silesia; Katowice Poland
| | - Adam Wylęgała
- Ophthalmology Department; Railway Hospital Katowice; II School of Medicine with the Division of Dentistry in Zabrze; Medical University of Silesia; Katowice Poland
| | - Bogumił Wowra
- Ophthalmology Department; Railway Hospital Katowice; II School of Medicine with the Division of Dentistry in Zabrze; Medical University of Silesia; Katowice Poland
| | - Łukasz Wójcik
- Ophthalmology Department; Railway Hospital Katowice; II School of Medicine with the Division of Dentistry in Zabrze; Medical University of Silesia; Katowice Poland
| | - Dariusz Dobrowolski
- Ophthalmology Department; Railway Hospital Katowice; II School of Medicine with the Division of Dentistry in Zabrze; Medical University of Silesia; Katowice Poland
| | - Edward Wylęgała
- Ophthalmology Department; Railway Hospital Katowice; II School of Medicine with the Division of Dentistry in Zabrze; Medical University of Silesia; Katowice Poland
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Yang AY, Chow J, Liu J. Corneal Innervation and Sensation: The Eye and Beyond. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2018; 91:13-21. [PMID: 29599653 PMCID: PMC5872636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The cornea is one of the most densely innervated and sensitive tissues in the body. In addition to their important sensory functions, corneal nerves induce reflex tear production, blinking, and the release of trophic factors - all of which combined help to maintain the structural and functional integrity of the surface of the eye. Consequently, damage to corneal nerves as a result of disease, surgery, or trauma can lead to diminished corneal sensitivity, epithelial defects, and possible blindness. In this review, we describe commonly used tools that have provided considerable new information on corneal architecture and sensation in healthy and diseased corneas, with special emphasis on changes seen in herpes zoster ophthalmicus, corneal and other therapeutic ocular procedures, antiglaucoma medical therapy, aging, and diabetes. With its potential applications ranging from managing ocular-specific to systemic diseases, the study of corneal innervation has implications for future therapies extending beyond just the eye itself.
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Affiliation(s)
| | | | - Ji Liu
- To whom all correspondence should be addressed: Ji Liu, MD, 40 Temple St. Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT 06510; Tel: 203-785-2020, Fax: 203-785-7090,
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Corneal Neurotization With a Great Auricular Nerve Graft: Effective Reinnervation Demonstrated by In Vivo Confocal Microscopy. Cornea 2018; 37:647-650. [DOI: 10.1097/ico.0000000000001549] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cavalcanti BM, Cruzat A, Sahin A, Pavan-Langston D, Samayoa E, Hamrah P. In vivo confocal microscopy detects bilateral changes of corneal immune cells and nerves in unilateral herpes zoster ophthalmicus. Ocul Surf 2017; 16:101-111. [PMID: 28923503 DOI: 10.1016/j.jtos.2017.09.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/05/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze bilateral corneal immune cell and nerve alterations in patients with unilateral herpes zoster ophthalmicus (HZO) by laser in vivo confocal microscopy (IVCM) and their correlation with corneal sensation and clinical findings. MATERIALS AND METHODS This is a prospective, cross-sectional, controlled, single-center study. Twenty-four eyes of 24 HZO patients and their contralateral clinically unaffected eyes and normal controls (n = 24) were included. Laser IVCM (Heidelberg Retina Tomograph/Rostock Cornea Module), corneal esthesiometry (Cochet-Bonnet) were performed. Changes in corneal dendritiform cell (DC) density and morphology, number and length of subbasal nerve fibers and their correlation to corneal sensation, pain, lesion location, disease duration, and number of episodes were analyzed. RESULTS HZO-affected and contralateral eyes showed a significant increase in DC influx of the central cornea as compared to controls (147.4 ± 33.9, 120.1 ± 21.2, and 23.0 ± 3.6 cells/mm2; p < 0.0001). In HZO eyes DCs were larger in area (319.4 ± 59.8 μm2; p < 0.001) and number of dendrites (3.5 ± 0.4 n/cell; p = 0.01) as compared to controls (52.2 ± 11.7, and 2.3 ± 0.5). DC density and size showed moderate negative correlation with total nerve length (R = -0.43 and R = -0.57, respectively; all p < 0.001). A higher frequency of nerve beading and activated DCs close to nerve fibers were detected specifically in pain patients. CONCLUSIONS Chronic unilateral HZO causes significant bilateral increase in corneal DC density and decrease of the corneal subbasal nerves as compared to controls. Negative correlation was observed for DC density and size to nerve parameters, suggesting interplay between the immune and nervous systems. Patients with chronic pain also showed increased nerve beading and activated DCs.
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Affiliation(s)
- Bernardo M Cavalcanti
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA; Post-Graduate Program, Surgery Department, Pernambuco Federal University (UFPE), Recife, PE, Brazil
| | - Andrea Cruzat
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Afsun Sahin
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA; Koc University Medical School, Research Center for Translational Medicine, Istanbul, Turkey; Boston Image Reading Center, Tufts University School of Medicine, Boston, MA, USA
| | - Deborah Pavan-Langston
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Eric Samayoa
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Pedram Hamrah
- Ocular Surface Imaging Center and Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA; Boston Image Reading Center, Tufts University School of Medicine, Boston, MA, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
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