Clinical and confocal imaging findings in congenital corneal anaesthesia

2020 ◽  
pp. bjophthalmol-2020-316672
Author(s):  
Rebecca Guillon-Rolf ◽  
Scott Hau ◽  
Daniel F P Larkin
Keyword(s):  
Visual Acuity ◽  
Confocal Microscopy ◽  
Fibre Length ◽  
Young Patients ◽  
Clinical Findings ◽  
Confocal Imaging ◽  
Corneal Ulceration ◽  
Good Visual Acuity ◽  
Branch Density

Background/AimsCongenital corneal anaesthesia (CCA) is an uncommon cause of corneal ulceration in young patients, with a reported poor visual prognosis. We correlated clinical findings in patients with CCA with corneal sub-basal nerve plexus (SBNP) morphology and dendritiform cell density (DCD) on confocal microscopy.MethodsA prospective, case–control study was conducted at a referral clinic. History includied presenting features in patients with CCA, clinical course and examination findings. Differences in SBNP morphology and DCD on in vivo confocal microscopy (IVCM) were compared in cases and control subjects with healthy corneas.ResultsEight patients with CCA were examined, of which three had a diagnosis of familial dysautonomia. Age at initial diagnosis of corneal disease ranged from infancy to 22 years, the most common presentation being corneal ulceration. All patients with CCA except one with optic neuropathy had corrected visual acuity 6/18 (logMAR 0.35) or better in at least one eye. Measured corneal sensation was minimal in all patients. Major abnormalities were found on confocal microscopy in all patients with CCA, whether or not inherited, including statistically significant reduction in SBNP nerve fibre density, fibre length and branch density. Increased DCD in superficial cornea was found in all patients with CCA.ConclusionGood visual acuity can be maintained in eyes with corneal anaesthesia present from birth. IVCM provides direct evidence of a morphological correlate for measured corneal anaesthesia. Increased DCD may indicate an enhanced role for innate immune cells in superficial cornea in protection of the anaesthetic ocular surface.

Bilateral morphometric analysis of corneal sub-basal nerve plexus in patients undergoing unilateral cataract surgery: a preliminary in vivo confocal microscopy study

2020 ◽  
pp. bjophthalmol-2019-315449 ◽  
Author(s):  
Giuseppe Giannaccare ◽  
Federico Bernabei ◽  
Marco Pellegrini ◽  
Fabio Guaraldi ◽  
Federica Turchi ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Cataract Surgery ◽  
Nerve Fibre ◽  
Fibre Length ◽  
Nerve Plexus ◽  
In Vivo Confocal Microscopy ◽  
Corneal Nerve ◽  
Branch Density ◽  
Unilateral Cataract

AimsTo evaluate bilateral morphometric changes of corneal sub-basal nerve plexus (CSNP) occurring after unilateral cataract surgery by in vivo confocal microscopy (IVCM) images analysed with automated software.MethodsIVCM was performed before (V0) and 1 month after surgery (V1) in both operated eyes (OEs) and unoperated eyes (UEs) of 30 patients. Thirty age and sex-matched subjects acted as controls. Corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), corneal nerve total branch density (CTBD), corneal nerve fibre area (CNFA), corneal nerve fibre width, corneal nerve fractal dimension (CNFrD) and dendritic cells density were calculated.ResultsMean CNFD, CNBD, CNFL, CTBD, CNFA and CNFrD significantly decreased at V1 versus V0 in both eyes (respectively, 15.35±7.00 vs 21.21±6.56 n/mm2 in OEs and 20.11±6.69 vs 23.20±7.26 in UEs; 13.57±12.16 vs 26.79±16.91 n/mm2 in OEs and 24.28±14.88 vs 29.76±15.25 in UEs; 9.67±3.44 mm/mm2 vs 13.49±3.42 in OEs and 12.53±3.60 vs 14.02±3.82 in UEs; 22.81±18.77 vs 42.25±24.64 n/mm2 in OEs and 38.06±20.52 vs 43.93±22.27 in UEs; 0.0040±0.0021 vs 0.0058±0.0020 mm2/mm2 in OEs and 0.0049±0.0016 vs 0.0057±0.0019 in UEs; 1.418±0.058 vs 1.470±0.037 in OEs and 1.466±0.040 vs 1.477±0.036 in UEs; always p<0.049).ConclusionPatients undergoing cataract surgery exhibit bilateral alterations of CSNP. This finding could have broad implications in the setting of sequential cataract surgery.

scholarly journals In Vivo Confocal Microscopy Evaluation in Patients with Keratoconus

2022 ◽  
Vol 11 (2) ◽  
pp. 393
Author(s):  
Alvin Wei Jun Teo ◽  
Hassan Mansoor ◽  
Nigel Sim ◽  
Molly Tzu-Yu Lin ◽  
Yu-Chi Liu
Keyword(s):  
Confocal Microscopy ◽  
Nerve Regeneration ◽  
Nerve Fibre ◽  
Ex Vivo ◽  
Fibre Length ◽  
In Vivo Confocal Microscopy ◽  
Corneal Sensitivity ◽  
Mechanical Removal ◽  
Cellular Changes

Keratoconus is the most common primary corneal ectasia characterized by progressive focal thinning. Patients experience increased irregular astigmatism, decreased visual acuity and corneal sensitivity. Corneal collagen crosslinking (CXL), a minimally invasive procedure, is effective in halting disease progression. Historically, keratoconus research was confined to ex vivo settings. In vivo confocal microscopy (IVCM) has been used to examine the corneal microstructure clinically. In this review, we discuss keratoconus cellular changes evaluated by IVCM before and after CXL. Cellular changes before CXL include decreased keratocyte and nerve densities, disorganized subbasal nerves with thickening, increased nerve tortuosity and shortened nerve fibre length. Repopulation of keratocytes occurs up to 1 year post procedure. IVCM also correlates corneal nerve status to functional corneal sensitivity. Immediately after CXL, there is reduced nerve density and keratocyte absence due to mechanical removal of the epithelium and CXL effect. Nerve regeneration begins after 1 month, with nerve fibre densities recovering to pre-operative levels between 6 months to 1 year and remains stable up to 5 years. Nerves remain tortuous and nerve densities are reduced. Corneal sensitivity is reduced immediately postoperatively but recovers with nerve regeneration. Our article provides comprehensive review on the use of IVCM imaging in keratoconus patients.

scholarly journals Confocal Imaging: In Vivo and Clinical Applications

1999 ◽  
Vol 7 (2) ◽  
pp. 8-11
Author(s):  
R.W. Beuerman ◽  
S.C. Kaufman ◽  
K.A. Palkama
Keyword(s):  
Confocal Microscopy ◽  
Laser Light ◽  
Basic Research ◽  
Optical Signal ◽  
Cellular Protein ◽  
Confocal Imaging ◽  
Design Strategies ◽  
Experimental Conditions ◽  
Fluorescent Substrate

Confocal microscopy is a collection of optical techniques that are applied in a variety of hardware configurations. Design strategies for the application of these techniques have generally used laser light (Pawley, 1990). In most laboratories, basic research use has employed laser light in conjunction with a fluorescent substrate to generate an optical signal, either through direct application of a fluorescent material to cells or by the stimulation of a chromophore associated with an antibody which will identify a cellular protein under some specified experimental conditions, The use of confocal microscopy in this type of situation generally requires a standard research microscope, and the tissue may be situated on a slide or other type of container that will provide a stable, controlled environment.

scholarly journals Crosslinking and Fulguration in the Treatment of Acanthamoebic Keratitis

2020 ◽  
Vol 17 (4) ◽  
pp. 725-732
Author(s):  
S. V. Trufanov ◽  
A. V. Zaitsev ◽  
N. P. Shakhbazyan
Keyword(s):  
Visual Acuity ◽  
Confocal Microscopy ◽  
Anterior Segment ◽  
Infection Process ◽  
Corneal Tissue ◽  
Before And After ◽  
Acanthamoebic Keratitis ◽  
Microscopy Data

Purpose: to study the combined Photo-Activated Chromophore for Keratitis — Corneal Cross-Linking (PACK-CXL) in combination with fulguration of the infiltration zone in the treatment of medically refractive acanthamoebic keratitis.Patients and methods. The study included 9 patients (10 eyes) with medically refractive acanthamoebic keratitis. The diagnosis was confirmed by confocal microscopy data from a microbiological study of scraping of corneal tissue from the lesion site with Romanovsky-Giemsa stain. All patients underwent combined surgical treatment of PACK-CXL with pre-fulguration. Optical coherence tomography (OCT) of the anterior segment of the eye was also performed using an RTVue-100 apparatus (Optovue USA), determination of visual acuity, photographing before and after surgery.Results. In 6 cases (60 %), a positive effect was noted, relief of the symptoms of the disease and the formation of turbidity within a month after the procedure, as well as an increase in the maximum corrected visual acuity. According in vivo confocal microscopy, 6 months after the intervention, no signs of infection were detected. In 4 cases, the therapeutic effect was absent. Subsequently, 3 patients (3 eyes) underwent therapeutic keratoplasty. In one eye, the infectious process was stopped medically for 6 months.Conclusion. The combined PACK-CXL method together with fulguration can be effective and safe in the treatment of medically refractive acanthamoebic keratitis, allowing keratoplasty to be performed with an optical goal if necessary, after stopping the infection process in a distant period. 

scholarly journals In vivo Confocal Microscopy in Differentiating Ipilimumab-Induced Anterior Uveitis from Metastatic Uveal Melanoma

2016 ◽  
Vol 7 (3) ◽  
pp. 404-409 ◽  
Author(s):  
Hayyam Kiratli ◽  
Mehmet C. Mocan ◽  
Murat İrkeç
Keyword(s):  
Visual Acuity ◽  
Confocal Microscopy ◽  
Uveal Melanoma ◽  
Anterior Uveitis ◽  
Choroidal Melanoma ◽  
Inflammatory Cells ◽  
In Vivo Confocal Microscopy ◽  
Keratic Precipitates ◽  
Metastatic Process

This report aims to describe the facilitating role of in vivo confocal microscopy in differentiating inflammatory cells from a metastatic process in a patient with uveal melanoma and multiple systemic metastases who developed anterior uveitis while under ipilimumab treatment. A 43-year-old woman developed systemic metastases 11 months after treatment of amelanotic choroidal melanoma in her right eye with 30 Gy fractionated stereotactic radiotherapy. She first received temozolomide and then 4 cycles of ipilimumab 3 mg/kg/day. After the third cycle, severe anterior uveitis with coarse pigment clumps on the lens was seen in the left eye. Her left visual acuity declined from 20/20 to 20/80. Confocal microscopy revealed globular keratic precipitates with hyperreflective inclusions and endothelial blebs all suggestive of granulomatous uveitis. The uveitic reaction subsided after a 3-week course of topical corticosteroids, and her visual acuity was 20/20 again. Although uveal melanoma metastatic to the intraocular structures of the fellow eye is exceedingly rare and metastasis masquerading uveitis without any identifiable uveal lesion is even more unusual, it was still mandatory to rule out this distant possibility in our particular patient who already had widespread systemic metastases. Confocal microscopy was a useful complementary tool by identifying the inflammatory features of the keratic precipitates.

In vivo intraoperative confocal microscopy for real-time histopathological imaging of brain tumors

2012 ◽  
Vol 116 (4) ◽  
pp. 854-860 ◽  
Author(s):  
Jennifer Eschbacher ◽  
Nikolay L. Martirosyan ◽  
Peter Nakaji ◽  
Nader Sanai ◽  
Mark C. Preul ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Brain Tumors ◽  
Real Time ◽  
Frozen Section ◽  
Confocal Imaging ◽  
Sodium Fluorescein ◽  
Current Standard ◽  
Microscopic Features ◽  
Definition Of

Object Frozen-section analysis is the current standard for the intraoperative diagnosis of brain tumors. Intraoperative confocal microscopy is an emerging technology with the potential to visualize tumor histopathological features and cell morphology in real time. The authors report their findings using this new intraoperative technology in vivo with sodium fluorescein contrast during the course of 50 microsurgical tumor resections. Methods Eighty-eight regions were visualized with confocal microscopy, and corresponding biopsy samples were examined with routine neuropathological analysis. The tumors studied included meningiomas, schwannomas, gliomas of various grades, and a hemangioblastoma. The confocal microscopic features of each tumor and of various artifacts inherent to the technology were documented. A pathologist working in a blinded fashion reviewed a subset of the images in a further evaluation of the usefulness of the device as a diagnostic tool. Results Overall, intraoperative confocal imaging correlated surprisingly well with corresponding traditional histological findings, including the identification of many pathognomonic cytoarchitectural features of various brain tumors. In the blinded study, 26 (92.9%) of 28 lesions were diagnosed correctly. Conclusions Further study will be necessary for better definition of the role of intraoperative confocal microscopy as a routine adjunct for intraoperative brain tumor diagnosis.

scholarly journals Corneal confocal microscopy detects small fibre neurodegeneration in Parkinson's disease using automated analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sze Hway Lim ◽  
Maryam Ferdousi ◽  
Alise Kalteniece ◽  
Lewis Kass-Iliyya ◽  
Ioannis N. Petropoulos ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Confocal Microscopy ◽  
Nerve Fibre ◽  
Fibre Length ◽  
Mean Difference ◽  
Nerve Branch ◽  
Corneal Confocal Microscopy ◽  
Corneal Nerve ◽  
Branch Density

AbstractWe studied the utility of corneal confocal microscopy (CCM) in detecting a reduction in corneal nerve parameters in a large cohort of patients with Parkinson’s disease (PD) compared to controls using a fully automated potentially scalable method of analysis. We also assessed if CCM parameters are related to the severity and sub-type of PD. 98 participants with PD and 26 healthy controls underwent CCM with automated corneal nerve quantification, MDS-UPDRS III, Hoehn and Yahr scale, Montreal Cognitive Assessment, Parkinson’s Disease Questionnaire-39 and PD subtype assessment. Corneal nerve fibre density (mean difference: − 5.00 no/mm2, 95% confidence interval (CI) [− 7.89, − 2.12], p = 0.001), corneal nerve branch density (mean difference: − 10.71 no/mm2, 95% CI [− 16.93, − 4.48], p = 0.003), corneal total branch density (mean difference: − 14.75 no/mm2, 95% CI [− 23.58, − 5.92], p = 0.002), and corneal nerve fibre length (mean difference: − 2.57 mm/mm2, 95% CI [− 4.02, − 1.12], p = 0.001) were significantly lower in PD participants compared to controls. There was no correlation between corneal nerve parameters and duration, severity or subtype of PD, cognitive function or quality of life. CCM with automated corneal nerve analysis identifies nerve fibre damage and may act as a biomarker for neurodegeneration in PD.

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