Confocal Microscopy of Corneal Dystrophies

Abstract

In vivo confocal microscopy (IVCM) of the cornea is becoming an indispensable tool in the cellular study of corneal physiology and disease. This technique offers non-invasive imaging of the living cornea with images comparable to that of ex vivo histology. The ability to provide high-resolution images of all layers in the living cornea has resulted in new discoveries of corneal pathology at the cellular level. The IVCM analysis of corneal dystrophies is of importance to clinicians, as current methods of diagnosis involve slit-lamp characteristics, genetic analysis, and invasive biopsy. IVCM is helpful in evaluating the morphological characteristics of corneal dystrophies at the histological level and may be helpful in diagnosis, determination of progression, and understanding the pathophysiology of disease. The purpose of this review is to describe the principles, applications, and clinical correlation of IVCM in the study of corneal dystrophies.

Reis-Bücklers Corneal Dystrophy: A Reappraisal Using in vivo and ex vivo Imaging Techniques

“…The correlation with AS-OCT, showing the anterior saw-tooth border of the abnormal deposits, helped us interpret the IVCM images. The focal epithelial deposits previously described with IVCM [7,9], and also observed in the present study, are actually in continuity with and similar to the abnormal material replacing Bowman's layer (fig. 3c, d).…”

“…Therefore, IVCM was developed to overcome this limitation, and it now provides better resolution and image contrast for the in vivo analysis of corneal structures [14,15]. With IVCM, an amorphous hyperreflective material was observed in RBCD at the basal epithelium, Bowman's layer and anterior stroma without inflammatory cells or signs of stromal activation [6,7,9,10]. We originally also observed epithelial cell alterations above this abnormal hyperreflective material.…”

“…Because the slitlamp cannot provide details of corneal structures at the cellular level, many corneal dystrophies and most particularly granular dystrophies are difficult to distinguish [5,6]. Recently developed in vivo imaging techniques such as in vivo confocal microscopy (IVCM) and anterior segment (AS) optical coherence tomography (OCT) are providing new insights into the clinical evaluation of corneal dystrophies [7,8]. In RBCD, IVCM studies have shown an abnormal hyperreflective dystrophic material in both the epithelium and Bowman layers [6,7,9,10].…”

“…Recently developed in vivo imaging techniques such as in vivo confocal microscopy (IVCM) and anterior segment (AS) optical coherence tomography (OCT) are providing new insights into the clinical evaluation of corneal dystrophies [7,8]. In RBCD, IVCM studies have shown an abnormal hyperreflective dystrophic material in both the epithelium and Bowman layers [6,7,9,10]. Similarly, AS-OCT is also providing high-resolution in vivo cross-sections of the cornea, and granular dystrophies have already been analyzed using this technique [11].…”

In vivo confocal microscopic corneal images in health and disease with an emphasis on extracting features and visual signatures for corneal diseases: a review study

“…It offers non-invasive visualisation of the living tissues and provides greyscale images with greatly increased resolutions over light biomicroscopy and biocytology, which both have been very rewarding approaches to improve definitions of disease phenotypes 1. This ability to provide high-resolution images of all layers in the living cornea has resulted in new discoveries in corneal pathology at the cellular level;2 it has been used in the detection and management of pathological and infectious conditions, corneal dystrophies, monitoring contact lens-induced corneal changes and for pre-surgical and post-surgical evaluation following laser vision correction (photorefractive keratectomy, laser-assisted in-situ keratomileusis, laser-assisted sub-epithelial keratectomy) 3…”