Clinical applications of corneal confocal microscopy

Mitra Tavakoli, Parwez Hossain, Rayaz A Malik, Mitra Tavakoli, Parwez Hossain, Rayaz A Malik

Abstract

Corneal confocal microscopy is a novel clinical technique for the study of corneal cellular structure. It provides images which are comparable to in-vitro histochemical techniques delineating corneal epithelium, Bowman's layer, stroma, Descemet's membrane and the corneal endothelium. Because, corneal confocal microscopy is a non invasive technique for in vivo imaging of the living cornea it has huge clinical potential to investigate numerous corneal diseases. Thus far it has been used in the detection and management of pathologic and infectious conditions, corneal dystrophies and ecstasies, monitoring contact lens induced corneal changes and for pre and post surgical evaluation (PRK, LASIK and LASEK, flap evaluations and Radial Keratotomy), and penetrating keratoplasty. Most recently it has been used as a surrogate for peripheral nerve damage in a variety of peripheral neuropathies and may have potential in acting as a surrogate marker for endothelial abnormalities.

Keywords: cornea; corneal confocal microscopy; corneal dystrophy; infective keratitis; neuropathy.

Figures

Figure 1
Figure 1
Optical principle of the confocal microscope. (Courtesy of Nidek Technologies, from Mastropasqua and Nubile 2002).
Figure 2
Figure 2
Confocal microscopic corneal images (a) superficial epithelium (b) Basal membrane (c) Bowman’s layer (d) anterior stroma (e) posterior stroma (f) Endothelium. (The instrument used for all the pictures in this paper was the Tomey Confoscan P4 in-vivo slit-scanning real-time confocal microscope (Erlangen, Germany)).
Figure 3
Figure 3
Confocal microscopic images of epithelial layer of cornea: (a) the superficial epithelial cells, (b) wing cells, (c) basal cells.
Figure 4
Figure 4
Confocal microscopic images of Bowman’s membrane with nerve fibres. (a) Tomey confoscan P4, (b) Nidek confoscan 4, (c) laser HRT II.
Figure 5
Figure 5
Confocal microscopic images of the stroma (a) anterior (b) posterior (c) stromal nerves.
Figure 6
Figure 6
Confocal microscopic images of the Descemet’s membrane.
Figure 7
Figure 7
Confocal microscopic image of the endothelium.
Figure 8
Figure 8
Measurement of corneal thickness using the Z-Scan mode of the TOMEY Confoscan P4.
Figure 9
Figure 9
Microdeposits in the stromal layer of a patient after PRK (a) after 1 week (b) after 6 months.
Figure 10
Figure 10
Image of corneal nerves in Bowman’s layer from (a) healthy subject (b) diabetic patient.

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