颗粒状角膜营养不良活体共焦显微镜形态学研究

目的研究颗粒状角膜营养不良角膜各层组织的共焦显微镜形态改变。方法应用Confoscan2.0共焦显微镜对13例(26眼)颗粒状角膜营养不良患者的角膜进行扫描检查,记录与分析各层角膜图像。结果所有患眼前基质细胞及16/26眼后基质细胞结构不清,排列紊乱,并可见短棒状多形性强反光;6/26眼前弹力层不规则并增厚,神经纤维密度明显下降;6/26眼角膜上皮基底细胞层可见不定型的强反光;2/26眼角膜上皮细胞边界不清,排列呈疏松的蜂窝状,并出现不透明的强反光;所有患者角膜内皮细胞形态基本正常。视力0.3以下的患眼角膜上皮细胞层、上皮基底细胞层、前弹力层、后基质层发生形态异常的比例高于0.3以上的患眼(P<0.05)。结论1.共焦显微镜可活体检查颗粒状角膜营养不良角膜组织各层结构,起到类似病理组织切片的作用。2.前基质层形态异常可能是颗粒状角膜营养不良最基本的共焦显微镜形态特征,病情越重,前基质层以外的其它层次发生形态异常的可能性越大,但内皮细胞层一般不受累。3.共焦显微镜检查对颗粒状角膜营养不良手术方式的选择具有一定的参考价值。     

共焦显微镜在不典型虹膜角膜内皮综合征诊断中应用

目的 探讨共焦显微镜检查在虹膜角膜内皮综合征临床诊断中的应用价值.方法 对8例(其中6例单眼患病,2例双眼患病)常规检查无法确诊的疑似虹膜角膜内皮综合征病例进行共焦显微镜检查.观察角膜内皮层病变结构.结果 活体共焦显微镜检查发现患眼角膜内皮细胞均偏大而且形状不规则,细胞核反光明显增高,可见散在双核、多核、偏位核及分叶核等改变,7例细胞边界模糊,部分病例有局灶内皮细胞缺失、胞内环形暗区、分裂状细胞等改变.此外,3例单眼患病病例的对侧眼在共焦显微镜下发现内皮细胞密度下降、大小不均等改变.最后确诊为原发性进行性虹膜萎缩型2例、Chandler综合征4例、Cogan-Reese综合征2例.结论 共焦显微镜可以在细胞水平上无创、高分辨率地观察到虹膜角膜内皮综合征患眼角膜内皮层特征性的显微结构改变,且不受角膜水肿的影响,大大提高了虹膜角膜内皮综合征诊断的准确性,并有助于早期诊断,具有很高的应用价值.     

应用共聚焦显微镜观察正常老年人角膜形态学的特点

目的:探讨正常老年人共焦显微镜下角膜各层组织的活体细胞形态学特征。方法:正常老年人19例22眼中央角膜应用共聚焦显微镜(confocal microscope through focus,CMTF)进行观察,记录上皮翼状细胞层、上皮基底细胞层、前基质层、后基质层、内皮层的细胞密度,选取每人上皮基底细胞层下神经丛和中后基质层神经最清晰图像,并记录此幅图像中神经纤维总长度、神经纤维直径、神经纤维数目和每100μm神经纤维包含的念珠状结构(beads)数目,同时比较不同眼别及不同性别之间上述计量和计数资料之间的差别;观察上皮翼状细胞层、上皮基底细胞层、前基质层、后基质层、内皮层及上皮基底细胞层下神经丛(subbasal epithelial nerve plexus)和中后基质层神经(stromal nerves)的组织形态。结果:上皮翼状细胞层、上皮基底细胞层、前基质层、后基质层、内皮层的细胞密度分别为2150±315,5270±539,859±137,627±184,2529±654个/mm2,上皮基底细胞层下神经丛每幅图像中神经纤维总长度、神经纤维直径和数目、每100μm神经纤维包含的念珠状结构分别为944±176μm,2.3±0.5μm,9.0±1.3条,4.9±1.4;中后基质层神经每幅图像中神经纤维总长度、神经纤维直径和数目、每100μm神经纤维包含的念珠状结构分别为306±138μm,5.6±1.7μm,1.8±1.5条,0.0±0.0。上述计量和计数资料左、右眼和男、女之间无统计学差异。同时观察到排列疏松、细胞间夹杂有无结构暗区的表层上皮细胞层,过度形态的翼状上皮细胞层,呈"斑马皮样"外观的基底细胞层,在角膜中后基质层有4眼(18%)可见到微皱褶(microfolds),在排列规则、多呈六边型的角膜内皮层发现有2眼(9%)出现类似滴状赘疣(pseudoguttata-like)结构。结论:共焦显微镜可以在实时、活体和三维空间从细胞水平对角膜各层结构进行定量和定性分析。     

共焦显微镜下虹膜角膜内皮综合征的角膜形态学观察

目的 观察共焦显微镜下虹膜角膜内皮综合征(ICE)的角膜各层组织的形态学特点.方法 观察型系列病例研究.对2000年1月至2007年6月在复旦大学附属眼耳鼻喉科医院眼科就诊的23例(23只眼)ICE患者,行共焦显微镜(NIDEK,Confoscan 3.0)下双眼检查.使用NAVIS软件记录和分析角膜各层组织图像,并使用SPSS 13.0软件对患眼的角膜内皮细胞密度、内皮细胞平均面积、六角形细胞比例及有核细胞比例进行单因素方差分析.结果 ICE患眼的角膜内皮细胞呈"风筝样"或"上皮细胞样",细胞形态失去正常的六角形外观,细胞排列紊乱,胞内可见高反光的细胞核,部分细胞内可见双核或细胞分裂象.随病程时间延长,患眼角膜内皮细胞密度和六角形细胞比例逐渐下降.病程短于1年、1～3年、3～5年及超过5年患者的角膜内皮细胞密度分别为(1687.1±122.6)、(1210.6±168.7)、(947.3±145.2)及(856.8±73.4)个/mm2;六角形细胞比例分别为(51.5±6.3)%、(39.8±9.2)%、(32.7±8.1)%及(24.1±5.6)%.随病程时间延长,患眼角膜内皮细胞平均面积和有核内皮细胞比例逐渐升高.病程短于1年、1～3年、3～5年及超过5年患者的内皮细胞平均面积分别为(678.3±56.3)、(928.7±96.2)、(1188.5±72.6)及(1337.5±60.8)μm2;有核细胞比例分别为(12.6±1.4)%、(56.8±3.7)%、(78.7±5.6)%及(84.3±2.8)%(F=7.158,7.736,6.876,14.452;均P=0.000).患眼基质细胞形态无异常,但是随病程延长,基质神经纤维逐渐增粗并明显扭曲.患眼上皮细胞的形态无异常.对侧眼角膜的各层形态结构无明显异常.结论 共焦显微镜下ICE患眼的角膜内皮细胞表现有一定特点,共焦显微镜对于判断ICE的病程进展有诊断价值.     

小切口下角膜后弹力层剥除联合深板层内皮移植术的实验研究

目的 探讨小切口下角膜后弹力层剥除联合深板层内皮移植术(DSEK)的手术方法、疗效、并发症、内皮细胞的评价及组织学检查.方法 为实验研究.将24只新西兰大白兔随机分为3组,每组8只兔(8只眼),供体为新西兰大白兔16只眼.A组于角膜缘处行5 mm长隧道切口,剥去角膜中央直径10 mm的后弹力层,将等大的带有少量基质的后弹力层内皮细胞膜片植入受体眼;B组行单纯角膜后弹力层环形撕除术;C组在角膜后弹力层剥除后行去内皮细胞的带少许角膜基质和后弹力层膜片植入.术后观察1个月,比较3组兔角膜的透明性、植片贴附情况、角膜内皮细胞密度及并发症情况.结果 A组8只眼术前角膜内皮细胞密度平均值为(2728±108)个/mm2,术后角膜均恢复透明,内皮细胞密度平均为(2195±77)个/mm2,差异有统计学意义(t=12.455,P＜0.001);组织切片证实角膜内皮细胞植片与受体植床愈合良好,层间无瘢痕形成.B组8只眼术后均有严重的角膜水肿,持续1个月未恢复,组织学检查术后28 d时仅在后弹力层剥除的交界处有极少数的内皮细胞长入.C组8只眼术后1周内角膜植片均水肿,5只眼植片脱位;术后至观察1个月,角膜中央水肿仍较明显,伴有角膜新生血管长入,组织学检查植片部位未见内皮细胞长入.结论 角膜后弹力层剥除联合深板层内皮移植术具有安全、损伤小、术后恢复快及无层间瘢痕的优点,是治疗大泡性角膜疾病的优选术式.     

激光共焦显微镜对正常人中央角膜的观察

目的:利用激光共焦显微镜观察正常人的中央角膜组织结构和细胞形态。方法:对54例(68眼)患者进行激光共焦显微镜连续扫描,使用激光共焦显微镜对其角膜中央区进行检查,拍摄各层角膜图像,观察组织结构和细胞形态,对细胞密度进行计数并分析。结果:角膜组织学结构:上皮细胞较其它细胞的体积小,数量多,随深度增加细胞逐渐变小。Bowman膜较薄,无明显细胞结构,层间有神经走形。基质层的细胞核围成"网眼"状结构,随深度加深,"网眼"变大,排列变松。Descemet膜表现为一个与后基质层和内皮层交织的移行带。内皮细胞为六边形结构,排列规则。角膜细胞密度:在各年龄组间,上皮细胞表层与基底层之间的差异均有统计学意义(P<0.01),前基质层细胞密度与中、后基质层密度之间有统计学差异(P<0.05)。A组和D组的内皮细胞密度有统计学差异(P<0.05)。其余各年龄段的角膜各层细胞密度,随年龄的增加,数差异均无统计学意义。结论:激光共焦显微镜可以在实时、活体和三维空间从细胞水平对角膜各层结构进行无创的定性定量分析,较传统光学共焦显微镜能获得更清晰、更密集的角膜图像,对角膜疾病的基础研究与临床诊断具有很高的价值。     

正常角膜基质细胞密度和角膜厚度的研究

目的观察Confoscan 2.0共焦显微镜下正常活体角膜影像表现,测量基质细胞密度与各层厚度.方法检查34例(48眼)正常人.记录图像,并计算基质细胞密度和各层厚度.结果基质细胞密度从前到后逐渐降低,前基质比后基质细胞密度明显增高(t=-9.016,P=0.000),Bowman膜下密度最高,为(1113.2±227)个/mm2.全基质细胞密度为(806.5±57)个/mm2.角膜中央厚度为(568.3±53.8)μm,基质层为(465.5±60.2)μm,上皮层为(58.5±20.4)μm.各层厚度均与全基质细胞密度无显著相关性(P＞0.05).结论Confoscan 2.0共焦显微镜能检测角膜基质细胞密度和各层厚度.     

人体角膜移植内皮排斥反应的共焦显微镜研究

目的：应用共焦显微镜探讨活体角膜内皮排斥反应的早期形态学特征和变化。方法：19例(19只眼)角膜移植术后发生内皮排斥反应的人群根据角膜内皮排斥反应轻重的不同分为轻、中、重三组。应用共焦显微镜(Confoscan2．0)对角膜植片进行检查，并分析其相关因素。结果：活体角膜内皮排斥反应特有的共焦显微镜改变主要包括：①早期发现在KP及其附近的内皮细胞面有少量的免疫细胞附着，紧靠KP处的角膜基质细胞出现轻度水肿，细胞排列较混乱，胞浆中出现少量空泡状暗区。②中期发现在内皮细胞表面可见较多的免疫细胞聚集并被完全激活，基质细胞明显水肿，细胞核不清楚，基质中有免疫细胞进入；可见由高反光的免疫细胞和不明成份的组织碎片混合组成内皮排斥线。③在晚期排斥的患者中可见大量“激活”的免疫细胞在角膜内皮细胞面聚集，内皮细胞几乎完全破坏；基质细胞明显水肿，部分被“激活”且伴有大量免疫细胞聚集。结论：①内皮排斥反应的早期能够发现角膜内皮面有免疫细胞沉积；②角膜内皮面的免疫细胞沉积与角膜内皮排斥反应的轻重成正相关；③角膜内皮排斥反应实际上是一个混合排斥反应的过程；④共焦显微镜对角膜内皮排斥反应具有实时、无创、敏感、准确以及可莺蒽、可比较、可活体观察等临床价值。     

共焦显微镜在角膜营养不良诊断中的应用

目的 探讨共焦显微镜在角膜营养不良诊断中的应用价值。设计 病例系列研究。研究对象 6例角膜营养不良，包括4例Reis-Bueckleas角膜营养不良、1例角膜斑点状营养不良、1例。Fuchs角膜内皮营养不良。方法 患者双眼行裂隙灯显微镜及共焦显微镜检查，选择病变在不同角膜层次的共焦显微镜图像，对角膜沉淀进行形态学评价，并与裂隙灯检查比较。主要指标角膜病变的裂隙灯显微镜及共焦显微镜图像。结果 共焦显微镜显示Reis-Bficklers角膜营养不良病变主要累及前部基质，包括角膜上皮、基底细胞及前弹力层；斑点状角膜营养不良病变仅累及基质层，而角膜上皮层及内皮层正常；在Fuchs角膜内皮营养不良中，可直接观察角膜小滴及角膜内皮情况。结论 共焦显微镜检查提供了一种评价角膜病变的方法，较裂隙灯显微镜的分辨率高。     

人体角膜内皮细胞的共焦显微镜研究

目的应用共焦显微镜观察活体角膜内皮细胞的形态学特征。方法应用共焦显微镜观察正常人（20例）、角膜炎（12例）、角膜移植术后（19例）、葡萄膜炎（5例）、大疱性角膜病变（3例）、角膜白斑（6例）、角膜营养不良（7例）、青光眼（10例）、圆锥角膜（17例）等患者的角膜内皮,分析所得活体角膜内皮图象,总结其形态学特征。结果活体共焦显微镜下角膜内皮的图象主要有8种：①完全正常角膜内皮。②水肿角膜内皮。③失代偿角膜内皮。④“激活”角膜内皮。⑤排斥角膜内皮。⑥有KP角膜内皮。⑦有“疣状物”的角膜内皮。⑧“双核”角膜内皮细胞。结论共焦显微镜能对活体角膜内皮进行实时、无创、准确以及可重复、可比较的观察。     

Comparison of confocal biomicroscopy and noncontact specular microscopy for evaluation of the corneal endothelium

PURPOSE: To compare the clinical efficacy of confocal biomicroscopy with that of noncontact specular microscopy for the evaluation of the corneal endothelium. METHODS: The corneal endothelium was examined in 14 normal subjects (28 eyes) and in 6 patients (11 eyes) with Fuchs corneal endothelial dystrophy using a noncontact specular microscope (SP-2000P, Topcon, Japan) and a confocal biomicroscope (ConfoScan, Tomey, Japan). The images and the calculated densities of corneal endothelial cells obtained by the 2 techniques were compared. RESULTS: For normal subjects, the images of corneal endothelial cells obtained by the 2 techniques were almost identical, although the density of these cells determined by confocal biomicroscopy (2916 +/- 334 cells/mm2) was slightly higher than that determined by noncontact specular microscopy (2765 +/- 323 cells/mm2). In contrast, whereas clear images of corneal endothelial cells, allowing the determination of cell density, were obtained for all 11 eyes of the patient group by confocal biomicroscopy, clear images were obtained for only 4 of these 11 eyes (36.4%) by noncontact specular microscopy. CONCLUSION: Both noncontact specular microscopy and confocal biomicroscopy revealed the shapes and number of endothelial cells in the normal cornea. However, for corneas with Fuchs dystrophy, clear images were obtained only by confocal biomicroscopy. Confocal biomicroscopy is thus an effective tool for evaluation of the diseased corneal endothelium.     

Confocal microscopy in cornea guttata and Fuchs'' endothelial dystrophy

AIMS: To report the appearances of cornea guttata and Fuchs' endothelial dystrophy from white light confocal microscopy. METHODS: Seven eyes of four consecutive patients with cornea guttata were prospectively examined. Of the seven eyes, three also had corneal oedema (Fuchs' dystrophy). In vivo white light tandem scanning confocal microscopy was performed in all eyes. Results were compared with non-contact specular microscopy. RESULTS: Specular microscopy was precluded by corneal oedema in one eye. In the remaining six eyes, it demonstrated typical changes including pleomorphism, polymegathism, and the presence of guttae appearing as dark bodies, some with a central bright reflex. In all seven eyes, confocal microscopy revealed the presence of round hyporeflective images with an occasional central highlight at the level of the endothelium. Changes in cell morphology and size were readily appreciated. CONCLUSION: By comparison with specular microscopy, the hyporeflective images with an occasional central highlight seen on confocal microscopy are consistent with the presence of guttae. Confocal microscopy may confirm the diagnosis of cornea guttata and Fuchs' endothelial dystrophy by demonstrating the presence of guttae. This technique is especially valuable in cases of corneal oedema, where specular microscopy may fail to visualise the endothelium. However, specular microscopy should remain the method of choice to evaluate the endothelium, principally because it is easier to use.     

A COMPARISON OF CORNEAL ENDOTHELIAL MORPHOLOGY IN CORNEA GUTTATA, FUCHS' DYSTROPHY AND BULLOUS KERATOPATHY

Changes on corneal endothelial specular microscopy were compared in 14 patients with cornea guttata, 4 patients with Fuchs' corneal dystrophy and 19 patients with various forms of bullous keratopathy. The patients with cornea guttata showed well marked guttae 1 to 6 endothelial cells in diameter in the endothelial mosaic and in the relief mode while the endothelial mosaic was usually otherwise within normal limits. In 2 patients with Fuchs' dystrophy the endothelium could be examined, showing gross guttae but a few areas of relatively normal endothelial cells. The unaffected eye of 3 other patients snowed findings similar to cornea guttata, but with some reduction in endothelial cell count in 2 patients. The patients with bullous keratopathy fell into 2 groups, one with gross reduction in cell count in a markedly abnormal endothelial cell mosaic, the other a mixed group with moderate reduction in cell count and numerous guttae. Some miscellaneous cases included one of aphakic peripheral bullous keratopathy, one associated with cyclitis and aphakia and 2 with idiopathic non-surgical bullous keratopathy. We believe the corneal endothelium is not grossly abnormal away from the guttae in Fuchs' dystrophy, but the gross guttata formation determines the endothelial dysfunction.     

Intraocular pressure and corneal biomechanics in Fuchs’ endothelial dystrophy and after posterior lamellar keratoplasty

Purpose: To evaluate the precision of techniques for measuring intraocular pressure (IOP) in corneas with presumably altered biomechanical properties. Methods: Intraocular pressure was measured with a Goldmann applanation tonometer (GAT), ocular response analyzer (ORA) and dynamic contour tonometer (DCT) in 70 eyes. Thirty‐five eyes were normal corneas, 18 eyes had Fuchs’ endothelial dystrophy, and 17 eyes had undergone Descemet’s stripping automated endothelial keratoplasty (DSAEK) surgery. Corneal hysteresis (CH), corneal resistance factor (CRF) as well as central corneal thickness (CCT) were recorded with the ORA. Results: The measured cornea‐corrected IOP using ORA was significantly higher than GAT in all three groups (p < 0.001). The DCT differed significantly from the Goldmann only in the Fuchs’ group (p = 0.04). The Goldmann and DCT showed no significant between‐group differences, whereas IOP measured with the ORA was different between groups (p < 0.001). CH in the DSEAK group differed significantly from the controls (p < 0.001), but there was no significant difference between the DSEAK and Fuchs’ groups (p = 0.21). CCT did not differ significantly between the DSAEK and Fuchs’ group (p = 0.47). However, both these groups differed significantly from the controls (p < 0.001). Conclusion: Corneal hysteresis and CRF are reduced in Fuchs’ endothelial dystrophy as well as after posterior lamellar keratoplasty. GAT and DCT seem to measure IOP correctly in patients with Fuchs’ endothelial dystrophy as well as after posterior lamellar keratoplasty. Corneal‐corrected IOP as measured with the ORA appears to overestimate IOP in patients with Fuchs’ endothelial dystrophy as well as after posterior lamellar keratoplasty.     

A comparison of corneal endothelial morphology in cornea guttata, Fuchs' dystrophy and bullous keratopathy

Changes on corneal endothelial specular microscopy were compared in 14 patients with cornea guttata, 4 patients with Fuchs' corneal dystrophy and 19 patients with various forms of bullous keratopathy. The patients with cornea guttata showed well marked guttae 1 to 6 endothelial cells in diameter in the endothelial mosaic and in the relief mode while the endothelial mosaic was usually otherwise within normal limits. In 2 patients with Fuchs' dystrophy the endothelium could be examined, showing gross guttae but a few areas of relatively normal endothelial cells. The unaffected eye of 3 other patients showed findings similar to cornea guttata, but with some reduction in endothelial cell count in 2 patients. The patients with bullous keratopathy fell into 2 groups, one with gross reduction in cell count in a markedly abnormal endothelial cell mosaic, the other a mixed group with moderate reduction in cell count and numerous guttae. Some miscellaneous cases included one of aphakic peripheral bullous keratopathy, one associated with cyclitis and aphakia and 2 with idiopathic non-surgical bullous keratopathy. We believe the corneal endothelium is not grossly abnormal away from the guttae in Fuchs' dystrophy, but the gross guttata formation determines the endothelial dysfunction.     

Screening human donor corneas during organ culture for the presence of guttae

AIMS: To detect the presence of guttae by means of light microscopy during organ culture and to evaluate the influence of the presence of guttae in the donor tissue on transplantation outcome. METHODS: Donor corneas were investigated for the presence of guttae by means of light microscopy at the end of organ culture. Recipient corneal buttons from patients with severe Fuchs' dystrophy and donor corneas with advanced guttae were first studied by light microscopy and subsequently by transmission electron microscopy. Lastly, 168 consecutive donor corneas were evaluated for the presence of guttae and issued for transplantation. RESULTS: Corneal specimens with Fuchs' dystrophy displayed numerous round highly reflecting guttae at the level of the corneal endothelium. Donor corneas with advanced guttae showed less numerous guttae. Among 168 organ cultured donor corneas issued for transplantation, low density guttae were found in 43 (25.6%) corneas. The endothelial cell density and figure coefficient were significantly lower and organ culture time was significantly higher in the cornea guttata group than in the control group. The presence of grouped guttae significantly decreased the adjusted graft survival. The incidence of postoperative stage 3 cornea guttata was significantly higher when grouped guttae were found (5/6) than when no guttae or scattered guttae were found (8/101). CONCLUSION: Cornea guttata can be detected during organ culture by means of light microscopy. It is associated with a decrease in endothelial cell figure coefficient and cell density. The presence of grouped guttae is associated with poorer graft survival and more frequent stage 3 cornea guttata in the graft after transplantation.     

Regional variability in corneal endothelial cell density between guttae and non-guttae areas in Fuchs endothelial corneal dystrophy

ObjectiveTo assess the regional variability of corneal endothelial cell density (ECD) between guttae and non-guttae areas in subjects with Fuchs endothelial corneal dystrophy (FECD) using non-contact specular microscopy and confocal microscopy.DesignRetrospective chart review from 2009 to 2014 at the Massachusetts Eye and Ear Infirmary.ParticipantsOne hundred fifteen eyes of 73 subjects with FECD.MethodsSubjects with FECD underwent same-day specular and confocal microscopy in the same eye. Clinical stage of disease was documented on the day of image acquisition. Regional variability of ECD associated with guttae and non-guttae areas was assessed. Manual endothelial cell counts were performed.ResultsThirty-two percent of subjects had high quality endothelial images by both specular and confocal microscopy. Of these subjects, 83% were classified clinically as early-stage FECD. There was a significant association between stage of disease and the ability to obtain high quality specular images (χ²; p = 0.0012). There was no difference in mean ECD derived from specular (1363 ± 594 cells/mm²) or confocal (1391 ± 493 cells/mm²; p = 0.75) images. There was a statistically significant decrease of 31.8 ± 21.7% in mean ECD in areas surrounding guttae (1296 ± 560 cells/mm²) compared to non-guttae areas (1926 ± 674 cells/mm²; p < 0.0001) as determined by confocal microscopy.ConclusionThese findings support confocal microscopy as an alternative to specular microscopy for evaluating the corneal endothelium of patients with FECD, especially those with advanced disease. Confocal microscopy also revealed regional differences in ECD in guttae and non-guttae areas in patients with FECD.     

Changes in corneal structure observed with confocal microscopy during Fuchs endothelial dystrophy

PURPOSE: The study aimed to in vivo evaluate corneal structure in Fuchs' dystrophy. MATERIAL AND METHODS: Forty-two eyes of 21 patients (11 women and 10 men) aged 34-80 (mean 60.8) were studied. Sixteen patients presented clinical symptoms. The cornea was examined using a Confoscan P4 scanning slit confocal microscope (Tomey). Before examination, the cornea was anesthetized with 0.5% propacaine (Alcaine, Alcon) in order to inhibit the corneopalpebral reflex. A 40x microscope objective was covered with a drop of polyarylic acid gel (Vidisic, Mann Pharma) and then it was moved horizontally close to the patient's cornea and the examination was carried out. RESULTS: In the early stage of Fuchs dystrophy, slit biomicroscopy revealed fine dark spots within the corneal endothelium, while in the advanced stage the cornea had the appearance of beaten metal. On confocal microscopy, there were diffused hyporeflective areas in the early-stage disease. The endothelial cells located beyond these areas were pleomorphic and polymegathic. In the late stage we observed diffused hyporeflective areas surrounded by hyperreflective endothelial cells, which could not be analyzed separately. Within the corneal stroma, the collagen fibers were blurred and the background illumination was increased. In the posterior part of the stroma, dark bands were seen. The epithelium contained cystic structures (blisters). The membranes of the basal cells were thickened and the background illumination was increased. CONCLUSIONS: Confocal microscopy allows to diagnose Fuchs dystrophy and visualize endothelial cells within the swollen cornea.     

Confocal microscopy of posterior polymorphous endothelial dystrophy

PURPOSE: To report the in vivo confocal microscopic findings of posterior polymorphous endothelial dystrophy (PPED). METHODS: Four patients with PPED from 2 unrelated families and 2 asymptomatic children of an index patient were included in this observational case series. The eyes of the 6 subjects were examined by confocal light microscopy. RESULTS: Confocal microscopy demonstrated craters, streaks, and cracks over the corneal endothelium surface. Pleomorphism and polymegathism were present in eyes with PPED. Guttae and clusters of abnormal endothelial cells were also identified in corneas of these PPED patients. These findings were absent in eyes without clinical manifestations of PPED. CONCLUSIONS: In vivo confocal microscopy is potentially useful for excluding suspected cases of subclinical PPED. Abnormalities in the Descemet membrane and endothelium were observed.     

In vivo confocal microscopy of fleck dystrophy

PURPOSE: To use in vivo confocal microscopy to evaluate corneas with fleck dystrophy. METHODS: Both eyes of three patients with corneal fleck dystrophy were examined with a scanning slit confocal microscope. Corneal epithelium, stroma, and endothelium were evaluated, as well as the basal epithelial and stromal nerves. RESULTS: The epithelium did not show any anomalies, but the basal nerves showed hyperreflective inclusions. Throughout the entire stroma, hyperreflective dots of various shapes were seen. These consisted mostly of spherical matter with a diameter of 3-5 microm and were sometimes enclosed in cyst-like structures. The majority of the stromal cells and stromal nerves appeared normal. The endothelial cell layer was unaffected. CONCLUSION: In vivo confocal microscopy demonstrates previously unreported inclusions in the basal nerves of fleck dystrophy corneas. In addition to this new finding, the study confirms earlier histopathologic reports, demonstrating accumulation of pathologic material in the stromal cells.