Cornea Confocal Microscopy: Utilities and Perspectives

Mapping Intimacies ◽

10.5772/intechopen.96272 ◽

2021 ◽

Author(s):

Eduardo Rojas Alvarez

Keyword(s):

Confocal Microscopy ◽

Corneal Transplantation ◽

Infectious Keratitis ◽

Corneal Dystrophies ◽

Corneal Confocal Microscopy ◽

Depth Study ◽

High Resolution Images ◽

Refractive Medium ◽

High Standards

The cornea is the ocular refractive medium with the greatest refractive power of the eye. The study of it is of vital importance for the diagnosis and follow-up of ophthalmological diseases with the aim of achieving high standards of visual acuity in our patients. Confocal microscopy of the cornea allows in-depth study of it, quickly, safely, painlessly, obtaining high-resolution images of the corneal sublayers. This chapter summarizes the procedure for performing corneal confocal microscopy, the normal characteristics of the tissue with real images of our patients, as well as a brief explanation of the main applications of this technology in the study of corneal dystrophies (keratoconus), in refractive surgery, corneal transplantation, infectious keratitis, glaucoma filtration bulla, among other topics.

Download Full-text

One-Year Follow-up of Corneal Confocal Microscopy After Corneal Cross-Linking in Patients With Post Laser In Situ Keratosmileusis Ectasia and Keratoconus

American Journal of Ophthalmology ◽

10.1016/j.ajo.2008.11.017 ◽

2009 ◽

Vol 147 (5) ◽

pp. 774-778.e1 ◽

Cited By ~ 78

Author(s):

George D. Kymionis ◽

Vasilios F. Diakonis ◽

Maria Kalyvianaki ◽

Dimitra Portaliou ◽

Charalampos Siganos ◽

...

Keyword(s):

Confocal Microscopy ◽

Cross Linking ◽

Corneal Confocal Microscopy ◽

One Year

Download Full-text

Epi-Off versus Epi-On Corneal Collagen Cross-Linking in Keratoconus Patients: A Comparative Study through 2-Year Follow-Up

Journal of Ophthalmology ◽

10.1155/2018/4947983 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

F. Cifariello ◽

M. Minicucci ◽

F. Di Renzo ◽

D. Di Taranto ◽

G. Coclite ◽

...

Keyword(s):

Visual Acuity ◽

Confocal Microscopy ◽

Comparative Study ◽

Corneal Thickness ◽

Treatment Modalities ◽

Cross Linking ◽

Corneal Confocal Microscopy ◽

Group 2 ◽

Group 1

Aim. To evaluate two different techniques of cross-linking: standard epithelium-off (CXL epi-off) versus transepithelial (CXL epi-on) cross-linking in patient with progressive keratoconus.Methods. Forty eyes from 32 patients with progressive keratoconus were prospectively enrolled from June 2014 to June 2015 in this nonblinded, randomized comparative study. Twenty eyes were treated by CXL epi-off and 20 by CLX epi-on, randomly assigned, and followed for 2 years. All patients underwent a complete ophthalmologic testing that included uncorrected and best corrected visual acuity, central and peripheral corneal thickness, corneal astigmatism, simulated maximum, minimum, and average keratometry, corneal confocal microscopy, Schirmer I and break-up time (BUT) tests, and the Ocular Surface Disease Index. Intra- and postoperative complications were recorded. The solution used for CXL epi-off comprised riboflavin 0.1% and dextran 20.0% (Ricrolin), whereas the solution for CXL epi-on (Ricrolin TE) comprised riboflavin 0.1%, dextran 15.0%, trometamol (Tris), and ethylenediaminetetraacetic acid. Ultraviolet-A treatment was performed with a UV-X system at 3 mW/cm2.Results. In both groups, a significant improvement in visual function (Group 1: baseline 0.36 ± 0.16 logMAR, two-year follow-up 0.22 ± 0.17 logMAR,p=0.01; Group 2: baseline 0.32 ± 0.18 logMAR, 2-year follow-up 0.27 ± 0.19 logMAR,p=0.01) was recorded. Keratometry remained unchanged in both groups. The mean corneal thickness showed a significant reduction (mean difference of corneal thickness: −55 micron and −71 micron, resp.). One-month after treatment, OSDI©reached 13.56 ± 2.15 in Group 1 (p=0.03) and 11.26 ± 2.12 in Group 2 (p=0.04). At confocal microscopy, abnormal corneal nerve alterations were found in both groups. Fibrotic reaction (43.75%) and activated keratocyte (62.6%) were more commonly recorded in Group 1 than in Group 2 (25.0% and 18.75%), withp=0.668and 0.356, respectively.Conclusion. Our findings demonstrate that both procedures are able to slow keratoconus progression. Both treatment modalities are equivalent in terms of results and related complications. CXL epi-on technique is preferable to CXL epi-off since it preserves the corneal thickness and improves visual acuity, also reducing the postoperative ocular discomfort during the study period.

Download Full-text

In vivo corneal confocal microscopy allows direct observation of microbiological features in infectious keratitis

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2014.s017.x ◽

2014 ◽

Vol 92 ◽

pp. 0-0

Author(s):

E WYLEGALA ◽

A SMEDOWSKI ◽

D TARNAWSKA ◽

A NOWINSKA ◽

D DOBROWOLSKI

Keyword(s):

Confocal Microscopy ◽

Direct Observation ◽

Infectious Keratitis ◽

Corneal Confocal Microscopy

Download Full-text

Histomorphological view of the cornea investigated by laser confocal microscopy in keratoplasty

Medical Council ◽

10.21518/2079-701x-2021-21-2-110-117 ◽

2022 ◽

pp. 110-117

Author(s):

D. A. Krakhmaleva ◽

Z. V. Surnina ◽

S. A. Malzhoen ◽

A. A. Gamidov

Keyword(s):

Confocal Microscopy ◽

Immune Cells ◽

Graft Rejection ◽

Penetrating Keratoplasty ◽

Corneal Transplantation ◽

Corneal Graft ◽

Rejection Reaction ◽

Corneal Graft Rejection

Introduction. Corneal transplantation is the most successful and commonly performed allotransplantation procedure as compared with other organs and tissues. Over 100,000 corneal transplantations are performed worldwide every year.Purpose. This study investigated whether in vivo confocal microscopy (IVCM) can aid in the diagnosis of a graft rejection reaction by detecting changes in cellular structures and density of immune cells after penetrating keratoplasty.Materials and methods. The study included thirty-four eyes of 34 patients who underwent penetrating keratoplasty (7 eyes with corneal graft rejection, 27 without rejection). The average age of patients is 51.1 ± 13.6 years (from 23 to 76 years). The follow-up period ranged from 12 to 36 months (24.5 ± 4.84 months). Follow-up was performed at 1, 3, 6, 12 months and annually after PKP. To study the morphology of the cornea all patients underwent IVCM to assess the basal epithelium, subbasal layer, stroma and endothelium. Immune cells were identified and evaluated for the shape, length of the processes and their density.Results. Patients with corneal graft rejection demonstrated significant accumulation of corneal dendritic-like immune cells compared to patients with non-rejected grafts. In addition, the cells acquired a more mature morphology (grade 2–3). The density of dendritic cells (DC) was 809.17 ± 342.19 (p < 0.001). A positive correlation was found between DC density and graft rejection (p < 0.001). As well the patients showed signs of endothelial failure with low endothelial cell density and pleomorphism, increased light scattering and hyperreflectivity of the stroma.Conclusions. In a complex of diagnostic measures, confocal microscopy may provide a valuable clinical adjunctive tool in diagnosis and management of early corneal graft rejection.

Download Full-text

Faculty Opinions recommendation of Early detection of nerve fiber loss by corneal confocal microscopy and skin biopsy in recently diagnosed type 2 diabetes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718289800.793492653 ◽

2014 ◽

Author(s):

Rayaz Malik

Keyword(s):

Type 2 Diabetes ◽

Confocal Microscopy ◽

Early Detection ◽

Skin Biopsy ◽

Nerve Fiber ◽

Corneal Confocal Microscopy

Download Full-text

Safety and efficacy of repeated crosslinking assisted by transepithelial double-cycle iontophoresis in keratoconus progression after primary corneal crosslinking

Eye ◽

10.1038/s41433-020-01365-1 ◽

2021 ◽

Author(s):

Huping Wu ◽

Lan Li ◽

Shunrong Luo ◽

Xie Fang ◽

Xumin Shang ◽

...

Keyword(s):

Visual Acuity ◽

Corneal Thickness ◽

Good Alternative ◽

Persistent Epithelial Defect ◽

Safety And Efficacy ◽

Corneal Epithelial ◽

Epithelial Damage ◽

Corneal Confocal Microscopy

Abstract Objectives To evaluate the safety and efficacy of repeated corneal collagen crosslinking assisted by transepithelial double-cycle iontophoresis (DI-CXL) in the management of keratoconus progression after primary CXL. Methods A retrospective analysis was conducted in the patients who underwent repeated CXL between 2016 and 2018. These patients were treated with DI-CXL if keratoconus progression was confirmed after primary CXL. Scoring of ocular pain and corneal epithelial damage, visual acuity, corneal tomography, in vivo corneal confocal microscopy (IVCM) was performed before and at 3, 6, 12, and 24 months after DI-CXL. Results Overall, 21 eyes of 12 patients (mean age 17.3 ± 1.9 years) were included in this study. Before DI-CXL, an average increase of 4.26 D in Kmax was detected in these patients with a mean follow-up interval of (23.0 ± 13.7) months. After DI-CXL, corneal epithelial damage rapidly recovered within days. Visual acuity remained unchanged with follow-up of 24 months. When compared to baseline, significant decreases were observed in Kmax (at 3 months) and K2 (at 3 and 6 months) after DI-CXL. Corneal thickness of thinnest point significantly decreased at 3 months postoperatively. When compared to baseline, no significant differences were found in any of the refractive or tomographic parameters at 12 and 24 months. IVCM revealed trabecular patterned hyperdense tissues after DI-CXL in the anterior stroma at the depth of 200 μm or more. No corneal infiltration or persistent epithelial defect was recorded after DI-CXL. Conclusion DI-CXL is safe and effective as a good alternative in stabilizing keratoconus progression after primary CXL.

Download Full-text

Comparison of Two Scales for Assessing Motor Development in Infants with down's Syndrome

The Occupational Therapy Journal of Research ◽

10.1177/153944928300300403 ◽

1983 ◽

Vol 3 (4) ◽

pp. 213-221 ◽

Cited By ~ 4

Author(s):

Joan Snyder Lydic ◽

Margaret A. Short ◽

David L. Nelson

Keyword(s):

Motor Development ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Motor Ability ◽

Before And After ◽

Partial Correlations ◽

Depth Study ◽

Movement Assessment ◽

Stability Results

The Peabody Developmental Scales (PDS) and the Movement Assessment of Infants (MAI) were examined for their abilities to detect subtle changes in motor development of infants with Down's syndrome Both assessments were administered to 10 infants before and after a 6-week period A t-test suggested that the MAI was sensitive to developmental changes in the subjects tested from initial test to follow-up. Similar testing using the PDS did not reveal significant differences in the scores, suggesting that the MAI was the more sensitive of the two instruments. When partial correlations were calculated for possible artifactual effects due to age, the MAI still demonstrated greater stability. Results indicate that, for infants with Down's syndrome, the MAI may be preferable to the PDS for detecting changes in motor ability over short periods. However, these results should be considered tentative until a more in-depth study is conducted using a larger number of subjects from a variety of clinical populations.

Download Full-text

Comparison of anterior and posterior chamber implantation of iris claw lens in corneal transplant patients

European Eye Research ◽

10.14744/eer.2021.09719 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Mine Esen Baris

Keyword(s):

Corneal Transplantation ◽

Posterior Chamber ◽

Corneal Transplant ◽

Complication Rates ◽

Transplant Patients ◽

Support Methods ◽

Iris Claw Lens ◽

Iris Claw ◽

Rejection Rates

INTRODUCTION: To compare the surgical outcomes of anterior chamber (AC) and posterior chamber (PC) implantation of iris claw lens (ICL) combined with penetrating corneal transplantation (P-CT), in eyes with no capsular support. METHODS: The records of 20 P-CT cases who underwent ICL implantation were retrospectively evaluated. The eyes were grouped according to the location of implantation; AC ICL and PC ICL. Pre- and post-surgical best-corrected visual acuity (BCVA), post-operative complications and graft rejection rates were compared between the two groups. Mean follow-up time was 28 (range, 12 and 76) months. RESULTS: ICLs were implanted during P-CT surgery in 14 (70%) eyes, and as a secondary procedure after P-CT in 6 (30%) eyes. ICLs were implanted in PC in 12 (60%) and in AC in 8 (40%) eyes. Mean preoperative BCVA was 0.064 (range, 0.001-0.02) in PC group and 0.02 (range, 0.001-0.1) in AC group (p=0.86). Mean postoperative BCVA was 0.17 (range, 0.0001-1.0) in PC group and 0.14 (range, 0.0001-0.4) in AC group (p=0.81). Glaucoma developed in 5 (41.6%) eyes with PC ICL. No eye with AC ICL developed glaucoma over time. DISCUSSION AND CONCLUSION: Both AC and PC ICL implantation provide favorable visual outcomes and complication rates in CT patients. However, PC implantation of ICL seems to increase glaucoma incidence.

Download Full-text