SUMMARY Iii-vivo corneal replicas were made in 20 cases of patients with superficial dendritic ulcers of the cornea. Histopathological study of the replicas and superficial epithelial cells showed that the dendrites are composed of rounded epithelial cells and variable sized syncytia containing bizarre shaped nuclei. Pseudopodia-like processes containing DNA and some RNA extend from the syncytia into the surrounding epithelial cells, which on coming into contact with these processes become rounded and liquefied to give rise to another syncytium. The epithelial cells adjacent to the dendrite are elongated and usually orientated parallel to the long axis of the lesion. Surrounding the terminal bulbs, they are disposed in an arcuate fashion. These cells show C-mitotic lesions, intranuclear and cytoplasmic inclusion bodies, and polykaryocyte formation. Microscopic examination of the corneal replicas shows the intranuclear lesions and rounding of cells up to about 2 mm away from the dendritic ulcers. These areas appear normal on clinical examination.The corneal scrapings of herpetic dendritic ulcers have been studied by Thygeson (1958) and Naib et al. (1967). These authors have described the giant polykaryocytes in the scrapings to be characteristic of herpes simplex keratitis. As the scrapings destroy the exact histological detail owing to the crumpling of cells this method does not provide a full histological picture. We have developed an in-vivo corneal replica technique to study the histopathology of superficial keratitis (Maudgal, 1976;Maudgal and Missotten, 1977;Missotten and Maudgal, 1977).With this technique we have been able to study the replication and maturation stages of the herpes virus and the formation of disseminating inclusion bodies in experimental herpes simplex keratitis in rabbits (Maudgal, 1976). In this paper we report the histopathology of human superficial dendritic lesions studied by the in-vivo corneal replica technique.
Subjects and methodsIn-vivo collodion corneal replicas were made in 20 patients diagnosed clinically to have superficial herpetic dendritic keratitis in 1 eye. The technique of making a corneal replica in vivo and preparing flat mounts has been described previously (Missotten Address for reprints: Professor L. Missotten, Oogziekten, A.Z. St. Rafael, Kapucijnenvoer 7, 3000 Leuven, Belgium and Maudgal, 1977). The replicas were examined by phase-contrast microscopy. After dissolving the collodion membrane in acetone the flat mounts of superficial epithelial cells were studied by phasecontrast and oblique-illumination microscopy. Later the flat mounts were stained by haematoxylin and eosin, acridine orange, and Love's toluidine blue ammonium molybdate (TBM) method (Pearse, 1968) and studied by light microscopy.
ResultsPhase-contrast microscopy of the replicas and the flat mounts of superficial epithelial cells shows that the dendritic ulcers (Fig. 1) are made up of different sized rounded epithelial cells many of which form varying sized syncytia (Figs. 2, 3, 4). The nodular ...