Abstract
Purpose
To study sub-basal corneal nerve alterations in patients with acute Acanthamoeba keratitis (AK) and fungal keratitis (FK), using laser in vivo confocal microscopy (IVCM).
Methods
A retrospective analysis of IVCM (Heidelberg Retina Tomograph 3/Rostock Cornea Module) images of 10 AK corneas and 4 FK corneas was performed, and the results compared with those of 10 normal and 12 acute herpetic keratitis (HK) corneas. Sub-basal corneal nerves were analyzed with respect to total number of nerves, main nerve trunks, branching pattern and total length of nerves per image, as well as tortuosity. For each variable, results for three frames were averaged and analyzed using analysis of variance.
Results
Total corneal nerve length was significantly (P<0.0001) reduced in patients with AK (193.4±124.5 μm) and FK (268.6±257.4 μm) when compared with normal controls (3811.84±911.4 μm). Total nerve counts in patients with AK (3.9±1.2) and FK (3.6±3.2) were significantly (P<0.0001) decreased in comparison with normal controls (24.7±5.5). The number of main nerve trunks and nerve branching was found to be significantly lower in AK and FK corneas, when compared with controls. There was a statistically significant decrease in the above parameters when compared with HK controls.
Conclusions
The sub-basal corneal nerve plexus is significantly diminished in eyes with AK and FK, as demonstrated by IVCM. These results are more profound than previously reported findings of a diminished nerve plexus in HK.
Similar content being viewed by others
Login or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Müller LJ, Marfurt CF, Kruse F, Tervo TM . Corneal nerves: structure, contents and function. Exp Eye Res 2003; 76: 521–542.
Nishida T . Neurotrophic mediators and corneal wound healing. Ocul Surf 2005; 3: 194–202.
Hamrah P, Cruzat A, Dastjerdi MH, Zheng L, Shahatit BM, Bayhan HA et al. Corneal sensation and subbasal nerve alterations in patients with herpes simplex keratitis. An in vivo confocal microscopy study. Ophthalmology 2010; 117: 1930–1936.
Oliveira-Soto L, Efron N . Morphology of corneal nerves using confocal microscopy. Cornea 2001; 20: 374–384.
Patel DV, McGhee CN . In vivo confocal microscopy of human corneal nerves in health, in ocular and systemic disease, and following corneal surgery: a review. Br J Ophthalmol 2009; 93: 853–860.
Rosenberg ME, Tervo TM, Müller LJ, Moilanen JA, Vesaluoma MH . In vivo confocal microscopy after herpes keratitis. Cornea 2002; 21: 265–269.
Zhang M, Chen J, Luo L, Xiao Q, Sun M, Liu Z . Altered corneal nerves in aqueous tear deficiency viewed by in vivo confocal microscopy. Cornea 2005; 24: 818–824.
Matsumoto Y, Dogru M, Sato EA, Katono Y, Uchino Y, Shimmura S et al. The application of in vivo confocal scanning laser microscopy in the management of Acanthamoeba keratitis. Mol Vis 2007; 13: 1319–1326.
Pfister DR, Cameron JD, Krachmer JH, Holland EJ . Confocal microscopy findings of Acanthamoeba keratitis. Am J Ophthalmol 1996; 121: 119–128.
Al-Aqaba M, Alomar T, Lowe J, Dua HS . Corneal nerve aberrations in bullous keratopathy. Am J Ophthalmol 2011; 151: 840–849.e1.
Patel DV, McGhee CN . Mapping the corneal sub-basal nerve plexus in keratoconus by in vivo laser scanning confocal microscopy. Invest Ophthalmol Vis Sci 2006; 47: 1348–1351.
Rosenberg ME, Tervo TM, Petroll WM, Vesaluoma MH . In vivo confocal microscopy of patients with corneal recurrent erosion syndrome or epithelial basement membrane dystrophy. Ophthalmology 2000; 107: 565–573.
Alomar TS, Nubile M, Lowe J, Dua HS . Corneal intraepithelial neoplasia: in vivo confocal microscopic study with histopathologic correlation. Am J Ophthalmol 2011; 151: 238–247.
Cruzat A, Witkin D, Baniasadi N, Zheng L, Jurkunas UV, Ciolino JB et al. Inflammation and the nervous system: the connection in the cornea in patients with infectious keratitis. Invest Ophthalmol Vis Sci 2011; 52: 5136–5143.
Oliveira-Soto L, Efron N . Morphology of corneal nerves in soft contact lens wear. A comparative study using confocal microscopy. Ophthalmic Physiol Opt 2003; 23: 163–174.
Acknowledgements
This work was supported by NIH K12-EY016335, NIH K08-EY-020575, the New England Corneal Transplant Research Fund and Falk Medical Research Foundation. The funding organizations had no role in the design or conduct of this research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Kurbanyan, K., Hoesl, L., Schrems, W. et al. Corneal nerve alterations in acute Acanthamoeba and fungal keratitis: an in vivo confocal microscopy study. Eye 26, 126–132 (2012). https://doi.org/10.1038/eye.2011.270
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/eye.2011.270
Keywords
This article is cited by
-
A 1-Year Randomized Study of the Clinical and Confocal Effects of Tafluprost and Latanoprost in Newly Diagnosed Glaucoma Patients
Advances in Therapy (2015)
-
Fungal Keratitis: Update for 2014
Current Ophthalmology Reports (2014)
-
Corneal nerve alterations in different stages of Fuchs’ endothelial corneal dystrophy: an in vivo confocal microscopy study
Graefe's Archive for Clinical and Experimental Ophthalmology (2014)
