Original article
Clinical Significance of Owl Eye Morphologic Features by In Vivo Laser Confocal Microscopy in Patients With Cytomegalovirus Corneal Endotheliitis

https://doi.org/10.1016/j.ajo.2011.07.026Get rights and content

Objective

To demonstrate the clinical significance of owl eye morphologic features observed by in vivo laser confocal microscopy in patients with cytomegalovirus (CMV) corneal endotheliitis.

Design

Observational case series.

Methods

participants: Six eyes of 6 patients (6 men; mean age, 73.3 years) with cytomegalovirus corneal endotheliitis diagnosed by clinical manifestations together with polymerase chain reaction from aqueous humor samples. intervention: All patients were examined by slit-lamp biomicroscopy and in vivo laser confocal microscopy. main outcome measures: Clinical manifestations were summarized by reviewing medical records. Selected confocal images of corneal layers were evaluated qualitatively for shape and degree of light reflection of abnormal cells and deposits.

Results

All patients had long histories of anterior uveitis with intraocular pressure elevation, corneal edema with keratic precipitates, and decrease of endothelial cell densities. Coin-shaped lesions were observed by slit lamp only in 1 patient at the first visit and in 2 additional patients at subsequent follow-up. In all patients, confocal microscopy demonstrated reduced subepithelial nerves, subepithelial opacity, increased reflectivity of keratocytes, highly reflective dots, and needle-shaped bodies. Owl eye morphologic features were observed consistently in all patients at the initial visit, and highly reflective round bodies were detected in 5 patients; most notably, these confocal features were reversible after resolution of endotheliitis.

Conclusions

Owl eye morphologic features and highly reflective round bodies observed by confocal microscopy may be useful as an adjunct for the noninvasive diagnosis of cytomegalovirus corneal endotheliitis. Reversibility of these features after resolution of endotheliitis may be useful for monitoring the therapeutic effects without multiple anterior chamber tap.

Section snippets

Methods

The study population consisted of 6 eyes of 6 consecutive patients (6 men; mean, 73.3 years), whose active CMV corneal endotheliitis was diagnosed and treated between April 2010 and March 2011 at the Department of Ophthalmology, Kanazawa University Hospital, Kanazawa, Japan (Patients 1 through 5), or the Department of Ophthalmology, Fukui-ken Saiseikai Hospital, Fukui, Japan (Patient 6; Table). The clinical diagnosis was performed based on slit-lamp findings of active corneal endotheliitis

Clinical Manifestations

The Table summarizes the clinical manifestations for 6 eyes of 6 patients. The mean follow-up period for all patients was 4.2 ± 2.5 months (range, 1 to 8 months). All patients were male (6/6; 100%) and had long histories (more than 2 years) of anterior uveitis (6/6; 100%) and IOP elevation of unknown origin (6/6; 100%) that was treated by corticosteroids and antiglaucoma agents (duration, 24 to 144 months; mean ± standard deviation, 84.0 ± 41.6 months). All patients had corneal edema (6/6;

Discussion

Herein, we report the clinical manifestations together with detailed in vivo laser confocal microscopic findings of all corneal cell layers in 6 Japanese patients with PCR-proven CMV corneal endotheliitis. To the best of the authors' knowledge, this is the largest series of confocal microscopic analyses of CMV corneal endotheliitis. The main highlight of the case series is the supportive diagnostic value of owl eye morphologic features by confocal microscopy. Most notably, we found that these

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