Abstract

P 182

Cytosine arabinoside induced alterations of corneal basal epithelium cells – a model of corneal epithelium proliferation kinetics?

Tietze B.¹, Becher J.², Guthoff R.^1
1Department of Ophthalmology, University of Wurzburg, ²Department of Internal Medicine II, University of Wurzburg

Objective: Atypical punctate kerathopathy occurs as a reversible side effect of dose dependant chemotherapy with cytosine arabinoside (ara-C). We analyzed atypical punctate keratopathy by in vivo confocal microscopy of a patient´s clinical course.
Methods: A 40-year-old patient suffered photophobia and visual impairment of both eyes at the second, respectively the third ara-C cycle (3g/m² intravenous every 12h for 3 days) under topical steroids. Both eyes showed numerous fluorescein-negative punctate epithelial opacifications, predominantly in the central cornea with a visual acuity (VA) of 1.0. After 14, respectively 11 days, corneal epithelium normalized with VA increase to 1.25. The opacifications (dots) were examined by confocal microscopy 1, 4 and 9 days after visual symptoms started.
Results: The dots were exclusively detected in the corneal epithelium and rarely near the corneal limbus. The dots were disseminated and hyperreflective with a maximum size of an epithelium cell. 490 dots/mm2 (median) were noticed only in the basal epithelial layer at day 1. At day 4, respectively day 9, 297 in basal cell layer and 140 dots/sqmm in superficial cell layer, respectively 140 and 295 dots/sqmm were found.
Conclusions: Ara-C is a cell cycle specific antimetabolite that inhibits DNA synthesis during S-cycle, and therefore inhibits cell division of proliferating epithelial cells. Only a small proportion of the corneal epithelium cells, observed by confocal microscopy as hyperreflective dots, seem to be involved. Thus, the path of proliferating basal epithelial cells and their differentiation into superficial cells of the cornea may be observed by confocal microscopy.

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