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      Is Open Access

      Clinical Correlation between Placido, Scheimpflug and LED Color Reflection Topographies in Imaging of a Scarred Cornea

      case-report

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          Abstract

          This case report aims to evaluate safety, efficacy and feasibility of anterior surface imaging by a novel point-source reflection topographer, in comparison to four other corneal imaging modalities. A 17-year-old female patient, clinically diagnosed with chronic herpetic keratitis in her left eye was imaged by a novel multicolored-spot reflection topography system. We comparatively investigated elevation and curvature maps between the novel topographer and established Placido disk topography and Scheimpflug tomography systems. Pachymetry maps were compared between the Scheimpflug system and anterior-segment optical coherence tomography system. The Placido system failed to properly register the abnormal anterior surface due to incomplete mire registration, while the Scheimpflug topometry device imaged the anterior surface properly, but not the posterior (due to media opacity), and thus pachymetry was highly irregular and erroneous in this case. Imaging of corneas infected with herpes simplex virus keratitis has been rare; we have not identified any such documentation in the peer review literature in the last 10 years. This novel multicolored-spot reflection topography imaging may offer successful corneal imaging in cases where established clinical topography systems may fail to produce accurate reconstruction of the corneal shape. This is an important case demonstrating exceptional clinical feasibility in such rare cases offered by a newly introduced technology in ophthalmic imaging.

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          Most cited references12

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          Herpes simplex keratitis.

          Herpes simplex keratitis (HSK) results from an infection with the herpes simplex virus type 1 (HSV-1) also known as human herpesvirus type 1 (HHV-1). Primary infection may involve an ocular or non-ocular site, following which latency might be established principally in the trigeminal ganglion but also in the cornea. During latency, the virus appears as a circular episome associated with histones with active transcription only from the region encoding the latency-associated transcript (LAT). The LAT region is implicated in neuronal survival, anti-apoptosis, virulence, suppression of transcription, establishment of and reactivation from latency. The initial keratitis may develop after infection through the "front door route" (entry into the ocular surface from droplet spread) or "back door route" (spread to the eye from a non-ocular site, principally the mouth). The initial ocular infection may be mild. Visual morbidity results from recurrent keratitis, which leads to corneal scarring, thinning and neovascularisation. Although, recurrent disease may potentially occur through anterograde axonal spread from the trigeminal ganglion to the cornea, recent evidence suggests that HSV-1 in the cornea may be another source of recurrent disease. The pathogenesis and severity of HSK is largely determined by an interaction between viral genes encoded by the strain of HSV-1 and the make up of the host's immune system. Herpetic stromal disease is due to the immune response to virus within the cornea and the ability of the strain to cause corneal stromal disease is correlated with its ability to induce corneal vascularisation. The pathogenesis of corneal scarring and vascularisation is uncertain but appears to be a complex interaction of various cytokines, chemokines and growth factors either brought in by inflammatory cells or produced locally in response to HSV-1 infection. Evidence now suggests that HSV-1 infection disrupts the normal equilibrium between angiogenic and anti-angiogenic stimuli leading to vascularisation. Thrombospondin 1 and 2, matricellular proteins, involved in wound healing are potent anti-angiogenic factors and appear to be one of the key players. Elucidating their roles in corneal scarring and vascularisation may lead to improved therapies for HSK.
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            Epidemiology of ocular herpes simplex. Incidence in Rochester, Minn, 1950 through 1982.

            Over the period 1950 through 1982, 122 Rochester, Minn residents had their first episode of ocular herpes simplex virus infection, for an age- and sex-adjusted incidence of 8.4 new cases per 100,000 person-years (95% confidence intervals [CI], 6.9 to 9.9 cases). These initial episodes involved lid or conjunctiva in 54%, superficial cornea in 63%, deeper cornea in 6%, and uveitis in 4%. An additional 29 residents had episodes of ocular herpes other than their first. Altogether, these 151 residents had 294 episodes of ocular herpes simplex infection, for an adjusted incidence of 20.7 episodes per 100,000 person-years (95% CI, 18.3 to 23.1 episodes). Age-adjusted rates by sex were comparable. There were no seasonal trends in incidence, but rates increased with time. On January 1, 1980, the prevalence of a history of ocular herpes simplex infection was 149 per 100,000 population (95% CI, 115 to 183).
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              In vivo three-dimensional corneal epithelium imaging in normal eyes by anterior-segment optical coherence tomography: a clinical reference study.

              To evaluate the safety and efficacy of real-time measurement of corneal epithelial thickness and investigate the distribution characteristics in a large normal-eye population using a clinically available spectral-domain anterior-segment optical coherence tomography (AS OCT) system.
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                Author and article information

                Journal
                COP
                COP
                10.1159/issn.1663-2699
                Case Reports in Ophthalmology
                S. Karger AG
                1663-2699
                2014
                September – December 2014
                01 October 2014
                : 5
                : 3
                : 311-317
                Affiliations
                aLaservision.gr Eye Institute, Athens, Greece; bNew York University Medical School, New York, N.Y., USA
                Author notes
                *A. John Kanellopoulos, MD, Laservision.gr Eye Institute, 17 Tsocha Street, GR-11521 Athens (Greece), E-Mail ajk@brilliantvision.com
                Article
                365962 PMC4224253 Case Rep Ophthalmol 2014;5:311-317
                10.1159/000365962
                PMC4224253
                25408671
                57f48b9e-9f26-41ef-aa9e-1a1d4bca4af9
                © 2014 S. Karger AG, Basel

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 4, Pages: 7
                Categories
                Published: October 2014

                Vision sciences,Ophthalmology & Optometry,Pathology
                Herpetic keratitis,Scheimpflug imaging,Corneal topography,LED Cassini,Color-coded topography,Irregular corneal astigmatism,Differential topography,Point-source topography,Pentacam HR

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