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In vivo confocal microscopy observation in a case of interstitial keratitis Ryota Suzuki 1 , Takashi Suzuki 1 , Takashi Itokawa 1 , Tomohiko Saito 1 , Koji Kakisu 1 , Yukinobu Okajima 1 , Yuichi Hori 1 1Department of Ophthalmology, Toho University Omori Medical Center pp.1099-1104
Published Date 2021/8/15
DOI https://doi.org/10.11477/mf.1410214075
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Abstract Purpose:Here we report a case of interstitial keratitis using In vivo confocal microscopy.

Case:A 43-year-old man had been attending another hospital for an unexplained corneal opacity in his right eye of unknown origin. He was treated with 0.1% betamethasone sodium phosphate eye drops, but his corneal opacity gradually worsened and he was referred to our department. The patient's right eye visual acuity was 0.08(0.7)and intraocular pressure was 11 mmHg on the initial examination. Slit-lamp microscopy showed opacity centered in the deep parenchyma of the entire cornea, while anterior optical coherence tomography showed enhanced signal intensity, consistent with parenchymal opacity. Based on the clinical findings, interstitial keratitis was diagnosed and polymerase chain reaction testing of the aqueous humor was negative for viral DNA. The 0.1% betamethasone sodium phosphate eye drops were continued, but his intraocular pressure increased to over 30 mmHg which suggested that he was a steroid responder. When the 0.1% betamethasone sodium phosphate eye drops were tapered off, his intraocular pressure decreased but his corneal opacity increased. In vivo confocal microscopy of the diseased cornea revealed hyperintense inflammatory cells in the deep corneal parenchyma and loss of the corneal nerve under the basal corneal epithelial cells. Subsequently, 0.1% ganciclovir eye drops, 0.1% fluorometholone eye drops, and 0.1% tacrolimus eye drops were prescribed, which normalized the intraocular pressure and did not enhance the corneal opacity.

Conclusion:The pathology of interstitial keratitis showed corneal nerve loss, and viral infection was considered as a possible etiology.


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