Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Japan.
Am J Ophthalmol. 2012 Mar;153(3):445-53. doi: 10.1016/j.ajo.2011.07.026. Epub 2011 Oct 25.
To demonstrate the clinical significance of owl eye morphologic features observed by in vivo laser confocal microscopy in patients with cytomegalovirus (CMV) corneal endotheliitis.
Observational case series.
participants: Six eyes of 6 patients (6 men; mean age, 73.3 years) with cytomegalovirus corneal endotheliitis diagnosed by clinical manifestations together with polymerase chain reaction from aqueous humor samples. intervention: All patients were examined by slit-lamp biomicroscopy and in vivo laser confocal microscopy. main outcome measures: Clinical manifestations were summarized by reviewing medical records. Selected confocal images of corneal layers were evaluated qualitatively for shape and degree of light reflection of abnormal cells and deposits.
All patients had long histories of anterior uveitis with intraocular pressure elevation, corneal edema with keratic precipitates, and decrease of endothelial cell densities. Coin-shaped lesions were observed by slit lamp only in 1 patient at the first visit and in 2 additional patients at subsequent follow-up. In all patients, confocal microscopy demonstrated reduced subepithelial nerves, subepithelial opacity, increased reflectivity of keratocytes, highly reflective dots, and needle-shaped bodies. Owl eye morphologic features were observed consistently in all patients at the initial visit, and highly reflective round bodies were detected in 5 patients; most notably, these confocal features were reversible after resolution of endotheliitis.
Owl eye morphologic features and highly reflective round bodies observed by confocal microscopy may be useful as an adjunct for the noninvasive diagnosis of cytomegalovirus corneal endotheliitis. Reversibility of these features after resolution of endotheliitis may be useful for monitoring the therapeutic effects without multiple anterior chamber tap.
通过活体激光共聚焦显微镜观察巨细胞病毒（CMV）角膜内皮炎患者的“猫头鹰眼”形态特征，阐明其临床意义。
观察性病例系列。
研究对象：6 例（6 名男性；平均年龄 73.3 岁）CMV 性角膜内皮炎患者的 6 只眼，这些患者均通过房水样本聚合酶链反应结合临床表现确诊。干预措施：所有患者均接受裂隙灯生物显微镜和活体激光共聚焦显微镜检查。主要观察指标：通过查阅病历总结临床表现。定性评估角膜各层的共焦图像，观察异常细胞和沉积物的形态和光反射程度。
所有患者均有长期的前葡萄膜炎伴眼内压升高、角膜水肿伴角膜后沉着物和内皮细胞密度降低病史。1 例患者在初次就诊时、另外 2 例患者在随后的随访中仅通过裂隙灯观察到硬币状病变。所有患者的共聚焦显微镜检查均显示上皮下神经减少、上皮下混浊、角膜细胞反射增加、高亮小点和针状小体。所有患者在初次就诊时均观察到一致的“猫头鹰眼”形态特征，5 例患者检测到高亮圆形小体；值得注意的是，这些共焦特征在内皮炎消退后是可逆的。
共聚焦显微镜检查观察到的“猫头鹰眼”形态特征和高亮圆形小体可能有助于非侵入性诊断 CMV 性角膜内皮炎。内皮炎消退后这些特征的可逆性可能有助于在无需多次前房穿刺的情况下监测治疗效果。
