Atlas of Ophthalmology

Endothelial Cell Edema in Keratouveitis due to Varicella Zoster Virus (Anterior Segment Colour Photography)

Cornea -> Keratitis, Infectious/ Non-Infectious
Patient: 65 years of age, male, BCVA 0.4, IOP 12 mmHg. Ocular Medical History: since 3 days decreased vision. Start of medical treatment for VZV, on suspicion of keratouveitis due to VZV. General Medical History: previous week skin involvement of the arm, typical for VZV ; serology indicated past, but not acute infection with CMV, HSV, and VZV (CMV-IgM negative, CMV-IgG positive, HSV-IgM negative, HSV-IgG positive, VZV-IgM negative, VZV-IgG positive, EBV-anti-VCA-IgG (CMIA) positive). Main Complaint: Decrease of vision. Purpose: to present endothelial cell edema in a patient with skin alterations, typical for Varicella Zoster Virus. Findings: Anterior Segment Colour Photography: regular corneal epithelium, thickened stroma, descement membrane thickening, nonreflecting endothelial changes . Discussion: The posterior comeal pathology of keratouveitis due to varicella zoster virus is not fully understood. There are several histopathological changes at the level of the endothelial cells/ Descemet's membrane causing an endothelial cell edema or inflammatory cell invasion between the endothelium and Descemet's membrane. Endothelial changes were observed in different phases of the disease. Reijo et al . (1) followed 14 patients with unilateral attacks of keratouveitis due to varicella zoster virus (VZV). He found that when the corneal edema had subsided, the mean endothelial cell density of the affected eyes was on average 15% lower than in the healthy fellow eyes. Patients with severe disease and an episode of high IOP had a 20% lower cell count in the diseased than in the healthy fellow eye. Literature: (1) Reijo A, Antti V, Jukka M. Endothelial cell loss in herpes zoster keratouveitis. Br J Ophthalmol. 1983 Nov;67(11):751-4.

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