Endothelial involvement indicates disease activity in Herpes simplex virus keratitis

Abstract

Abstract Purpose Corneal endotheliitis is a potentially sight‐threatening clinical manifestation of herpes simplex virus (HSV) keratitis. Early detection and consequent treatment may prevent development of endothelial decompensation. The goal of this previously published study was to describe the morphological features, frequency, and clinical consequences of endothelial involvement in HSV keratitis as seen by in vivo confocal microscopy (IVCM). Methods We examined both eyes of 250 patients with HSV keratitis by slit‐lamp and IVCM. All examinations were assessed for endothelial deviations characteristic of endotheliitis. To determine the specificity, we reviewed our IVCM database for morphologically comparable alterations. This database included 200 healthy volunteers and 1400 patients with various corneal pathologies. The endothelial cell density (ECD) change between the first and last visits of patients with HSV keratitis was evaluated. Results Endotheliitis‐specific deviations were detected in 107 of 250 patients with HSV keratitis (43%). Pseudoguttata, enlarged intercellular gaps, infiltration of inflammatory cells into the endothelial layer, loss of defined cell boundaries, spot‐like holes, and endothelial denudation disappeared within 3 weeks with appropriate antiviral and anti‐inflammatory treatment. Alterations were non‐specific for HSV keratitis. Similar alterations were detected in adenoviral, fungal, bacterial, and acanthamoeba keratitis. The HSV affected eyes with endothelial involvement showed a mean ECD decrease of 10.3% per year. Conclusion Endothelial involvement indicates inflammatory activity in HSV keratitis and is associated with irreversible endothelial cell loss. IVCM allows early detection and follow up of endotheliitis‐specific alterations.