Observation of Changes in Dendritic Cells in Patients with Herpes Simplex Stromal Keratitis Using In Vivo Confocal...

Objectives: To analyze changes in ocular dendritic cells and their correlation with signs of keratitis in patients with herpes simplex stromal keratitis (HSK) using in vivo confocal microscopy (IVCM). Methods: This was a retrospective, cross-sectional, controlled, single-center study. Fifty-nine eyes from 59 patients with HSK and 40 eyes from 40 control subjects were studied. Each patient underwent IVCM and slit-lamp examinations. The density, area, size, and number of dendritic cells (DCs) in the corneas of both groups were analyzed. The severity of HSK was assessed, and the morphology and density of DCs in the cornea in the HSK group, categorized by ocular parameter severity levels, were compared with those in the control group. Results: DC density was significantly greater in patients with HSK than in controls. The DC field and size and the number of branches were also significantly greater in the HSK group. Furthermore, the DC density increased and morphological changes were exacerbated with increasing degree of corneal edema. The DC density was significantly increased and morphological changes were significantly exacerbated in the HSK group compared to the control group, even in those with the mildest cases of HSK. Conclusions: DC density and morphological changes correlate with the degree of corneal edema in patients with HSK. Changes in DC density and morphology can be observed even in mild cases of HSK. IVCM may be a powerful tool for monitoring ocular surface immune responses in patients with HSK, aiding in the clinical diagnosis and management of this disease.