Porzukowiak Tina Renae, Ly Kelly
*OD, FAAO †BS Midwestern University Arizona College of Optometry, Glendale, Arizona (both authors).
Optom Vis Sci. 2015 Dec;92(12):e431-6. doi: 10.1097/OPX.0000000000000729.
The use of in vivo confocal microscopy has been valuable in detecting and managing corneal pathology. This case study documents endotheliitis using in vivo confocal microscopy where apparent resolution of endothelial edema on clinical examination resulted in the discovery of subclinical findings with confocal scanning. The purpose of this case study was to discuss a rare corneal pathology and the clinical value of confocal scanning.
A 30-year-old Asian Indian woman presented with unilateral endotheliitis and trabeculitis of presumed varicella zoster virus etiology. She was treated successfully with oral antiviral and topical corticosteroid therapy. Subclinical endotheliitis was detected using in vivo confocal microscopy, prompting the continuation of prophylactic, low-dose, topical corticosteroid therapy and topical hyperosmotics.
Further research is warranted to better understand the role of confocal microscopy in endotheliitis therapeutic management, endothelial cell count and morphology, and keratic precipitate characterization. To date, prophylactic oral antivirals and/or topical corticosteroids may play a role in immune suppression of the herpes virus, although prospective, randomized, controlled clinical trials have not focused specifically on endotheliitis cases.
体内共焦显微镜在检测和处理角膜病变方面具有重要价值。本病例研究记录了利用体内共焦显微镜诊断内皮炎的情况，在临床检查中内皮水肿看似消退，但共焦扫描却发现了亚临床病变。本病例研究的目的是探讨一种罕见的角膜病变以及共焦扫描的临床价值。
一名30岁的亚洲印度裔女性，出现单侧内皮炎和小梁炎，推测由水痘-带状疱疹病毒引起。她通过口服抗病毒药物和局部使用皮质类固醇激素治疗成功。利用体内共焦显微镜检测到亚临床内皮炎，促使继续进行预防性、低剂量局部皮质类固醇激素治疗和局部使用高渗剂。
有必要进行进一步研究，以更好地了解共焦显微镜在内皮炎治疗管理、内皮细胞计数和形态以及角膜后沉着物特征方面的作用。迄今为止，预防性口服抗病毒药物和/或局部皮质类固醇激素可能在疱疹病毒的免疫抑制中发挥作用，尽管前瞻性、随机、对照临床试验尚未专门针对内皮炎病例。
