J Korean Ophthalmol Soc.  2013 Dec;54(12):1923-1928.

In Vivo Confocal Microscopic Findings of Corneal Tissue in Bullous Keratopathy

• Park YM
• Kwon HJ
• Lee JS

Abstract

PURPOSE
To analyze the morphology and density of corneal tissue in patients with bullous keratopathy using in vivo confocal microscopy (IVCM).
CASE SUMMARY
Four eyes of 4 patients with clinically diagnosed bullous keratopathy were examined using IVCM. Cross-sectioned corneal images of the corneal epithelium, Bowman's layer, stromal layer, Descemet's membrane, and endothelium were evaluated. In bullous keratopathy patients, the outline of corneal epithelial wing cells was blurred. Several hyper-reflective whitish dots were found at the corneal epithelial level and a reduction in the density and thickness of the corneal nerves was observed. There was also a reduction in the density of the stromal keratocytes. The outline of the stromal keratocytes was blurred. Some keratocytes resembled myofibroblast. The hypo-reflective vertical strands were observed in the stroma adjacent to the Descemet's membrane. Endothelium showed hyper-reflectivity with associated increased endothelial pleomorphism and polymegathism.
CONCLUSIONS
In patients with bullous keratopathy, IVCM showed tissue edema in the corneal epithelium, stroma, and endothelium. Hyper-reflectivity appearances were noted due to the increase in the metabolic rate of the cells or extracellular matrix accumulation. Corneal endothelium showed morphological changes.

Keyword

Bullous keratopathy; Confocal microscopy Address

MeSH Terms

Descemet Membrane
Edema
Endothelium
Endothelium, Corneal
Epithelium, Corneal
Extracellular Matrix
Humans
Microscopy, Confocal
Myofibroblasts

Figure

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  Figure 1. In vivo confocal biomicroscopy of the corneal epithelium. (A) Normal appearance of the corneal epithelial wing cells seen in a healthy control. (B) The outline of corneal epithelial wing cells is blurred. Diffuse corneal edema is noted. Some hyper-reflective whitish dots are found.

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  Figure 2. In vivo confocal biomicroscopy of the corneal nerves. (A) Normal appearance of the sub-basal nerve plexus seen in a healthy control. (B) Sub-basal nerve plexus appearance in bullous keratopathy. There is a reduction in the density and thickness of the nerves. The outline of corneal keratocyte is blurred.

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  Figure 3. In vivo confocal biomicroscopy of the corneal stroma. (A) Normal appearance of the stroma and keratocytes seen in a healthy control. (B) There is a reduction in the density of the keratocytes in the anterior stroma. The outline of the stromal keratocytes is blurred. Some keratocytes resemble myofibroblast.(C) The hypo-reflective vertical strands are seen in the stroma adjacent to the descemet membrane.

• 

  Figure 4. In vivo confocal biomicroscopy of the corneal endothelium. (A) Normal appearance of the corneal endothelium seen in a healthy control. (B) Endothelial hyper-reflectivity with associated endothelial pleomorphism and polymegatism.

Reference

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