Laser Scanning In Vivo Confocal Microscopy Demonstrating Significant Alteration of Human Corneal Nerves Following Herpes Zoster Ophthalmicus

Abstract

60-YEAR-OLD WOMAN with herpes zoster ophthalmicus(HZO) of the right eye was treated with 800 mg ofacyclovir5timesperdayfor7days. Therewasnosignificantmedicalhis- tory. She developed reduced vision and ocular pain due to HZO disci- form keratouveitis (a central disc- like region of corneal edema with objective of the microscope was placedincontactwiththecorneaand thepatientwasaskedtofixateondis- tance targets arranged in a grid pat- tern to enable acquisition of mul- tipleconfocalimagesoverawidearea of cornea. Macromedia Freehand 10 (SanFrancisco,California)wasused to arrange images into wide-field montages of the subbasal nerve plexus. A montage of the left sub- basal nerve plexus demonstrated nerve fiber bundles arranged in a ra- diatingpattern,convergingtoforma typical clockwise whorl, or vortex, pattern,andLangerhans(antigenpre- senting) cells were distributed throughout the imaged region (Figure 1). In contrast, a montage of the right subbasal nerve plexus could not be produced owing to the scarcity of subbasal nerves. Indeed, only occasional nonbranching sub- basal nerves were visible in the mid- peripheral cornea (Figure 2A) and most images of the right cornea con- sisted of a bare, nerve-free Bowman layer (Figure 2B) with Langerhans cells (Figure 2C). COMMENT