Simon M W, Miller D, Pflugfelder S C, Murchison J F, Huang A J, Atherton S S
Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL 33136.
Ophthalmology. 1992 Sep;99(9):1408-13. doi: 10.1016/s0161-6420(92)31802-0.
The objective of this study is to prospectively compare the sensitivity and specificity of immunodetection of herpes simplex virus (HSV) in impression cytology specimens obtained directly from presumed herpesvirus dendritic epithelial keratitis with virus isolation by tissue culture of cells scraped from the same lesion.
Corneal impression cytology and tissue culture were performed on 29 consecutive patients presenting with presumed herpesvirus dendritic epithelial keratitis during a 6-month period. Impression cytology of dendritic epithelial keratitis lesions with Millipore Biopore membranes were evaluated for the presence of antigens specific to HSV type I (HSV-1), HSV-2, and varicella-zoster virus (VZV) using monoclonal antibodies specific to these herpesviruses and immunofluorescent staining techniques.
Tissue culture was positive for HSV-1 in 52% (13 of 25) of dendritic epithelial keratitis patients without skin lesions, and was negative for VZV in 4 patients with dendritic epithelial keratitis and skin lesions in the distribution of the first division of the trigeminal nerve. The remaining 12 tissue cultures showed no cytopathic effect. Compared with tissue culture, impression cytology was 100% sensitive (13 of 13) and 92% specific (11 of 12) for the diagnosis of HSV-1 dendritic epithelial keratitis (Kappa coefficient of agreement 0.92). Although our sample size for VZV dendritic epithelial keratitis was small, the impression cytology findings correlated with our clinical diagnosis more often than tissue culture (2 of 4 versus 0 of 4).
Impression cytology allows simultaneous debridement of dendritic epithelial keratitis and, when combined with immunocytologic staining procedures, provides a simpler, more rapid, and less expensive alternative to tissue culture for the diagnosis of dendritic epithelial keratitis caused by HSV or VZV.
本研究的目的是前瞻性地比较直接从疑似疱疹病毒性树枝状上皮角膜炎获取的印片细胞学标本中单纯疱疹病毒（HSV）免疫检测的敏感性和特异性，与通过对同一病变刮取的细胞进行组织培养进行病毒分离的结果。
在6个月期间，对29例连续出现疑似疱疹病毒性树枝状上皮角膜炎的患者进行角膜印片细胞学检查和组织培养。使用针对这些疱疹病毒的单克隆抗体和免疫荧光染色技术，评估用密理博生物孔膜对树枝状上皮角膜炎病变进行印片细胞学检查时是否存在I型单纯疱疹病毒（HSV-1）、HSV-2和水痘-带状疱疹病毒（VZV）的特异性抗原。
在无皮肤病变的树枝状上皮角膜炎患者中，52%（25例中的13例）的组织培养HSV-1呈阳性，在4例三叉神经第一分支分布区有树枝状上皮角膜炎和皮肤病变的患者中，VZV组织培养呈阴性。其余12次组织培养未显示细胞病变效应。与组织培养相比，印片细胞学对HSV-1树枝状上皮角膜炎诊断的敏感性为100%（13例中的13例），特异性为92%（12例中的11例）（一致性卡方系数为0.92）。虽然我们的VZV树枝状上皮角膜炎样本量较小，但印片细胞学检查结果与临床诊断的相关性比组织培养更常见（4例中的2例对4例中的0例）。
印片细胞学检查可同时对树枝状上皮角膜炎进行清创，当与免疫细胞染色程序结合时，为诊断由HSV或VZV引起的树枝状上皮角膜炎提供了一种比组织培养更简单、更快速且成本更低的替代方法。
