Yokogawa Hideaki, Kobayashi Akira, Mori Natsuko, Sugiyama Kazuhisa
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Clin Ophthalmol. 2015 Sep 24;9:1771-7. doi: 10.2147/OPTH.S92517. eCollection 2015.
To produce a two-dimensional reconstruction map of dendritic lesions in patients with herpes simplex keratitis (HSK) using in vivo confocal microscopy.
Four eyes of four patients (mean 65.8 years) with HSK presenting with a dendritic lesion were enrolled. Slit-lamp biomicroscopy and in vivo laser confocal microscopy were performed. Acquired confocal images at the level of the epithelium were arranged and mapped into subconfluent montages. Changes in the shape and degree of light reflection of abnormal cells and deposits around dendritic lesions as well as other corneal layers were qualitatively evaluated.
Mapping of dendritic lesion was successful in all cases, and the subconfluent montages clearly showed the larger image of dendritic lesion. In all cases, the dendritic lesion consisted of hyperreflective irregular epithelial cells, and was surrounded by distorted and elongated epithelial cells. In three cases, hyperreflective deposits were noted at the midline of the lesion. The corneal stroma showed a hyperreflective honeycomb pattern. In two cases, inflammatory cells were observed at the level of endothelial cell layer.
Mapping of dendritic lesions in patients with HSK was successful in all patients using in vivo confocal microscopy. Cellular level observation of dendritic lesion at a relatively larger magnification may help understand the in vivo morphological change of HSK. Further study in more patients with HSK and nonherpetic dendritic lesion is needed to utilize confocal microscopy images in differential diagnosis and follow-up of the epithelial lesions with dendrite.
使用活体共聚焦显微镜制作单纯疱疹病毒性角膜炎（HSK）患者树突状病变的二维重建图。
纳入4例（平均年龄65.8岁）出现树突状病变的HSK患者的4只眼。进行裂隙灯生物显微镜检查和活体激光共聚焦显微镜检查。将获取的上皮层水平的共聚焦图像进行排列并拼接成亚汇合蒙太奇图像。对树突状病变周围异常细胞和沉积物以及其他角膜层的形状和光反射程度变化进行定性评估。
所有病例均成功绘制树突状病变图，亚汇合蒙太奇图像清晰显示了树突状病变的更大图像。所有病例中，树突状病变均由高反射不规则上皮细胞组成，并被扭曲和拉长的上皮细胞包围。3例病例中，在病变中线处可见高反射沉积物。角膜基质呈现高反射蜂窝状图案。2例病例在内皮细胞层水平观察到炎性细胞。
使用活体共聚焦显微镜在所有HSK患者中成功绘制了树突状病变图。以相对较大的放大倍数对树突状病变进行细胞水平观察可能有助于了解HSK的体内形态变化。需要对更多HSK患者和非疱疹性树突状病变患者进行进一步研究，以利用共聚焦显微镜图像进行树突状上皮病变的鉴别诊断和随访。
