Contemporaryin vivoconfocal microscopy of the living human cornea using white light and laser scanning techniques: a major review

Abstract

In vivo confocal imaging of the cornea has evolved exponentially over the last few decades and it has increasingly emerged from the laboratory to be used in the clinical setting in relation to inherited corneal diseases, corneal infections, contact lens wear and the effects of corneal surgery. This evolution has led to significant enhancement of our knowledge of the living cornea in both its physiological and pathological states. A number of in vivo confocal microscope devices using white, and more recently coherent, light sources have been developed to provide non-invasive assessment of the corneal microstructure at a lateral resolution of 1-2 microm. The fundamental principles of in vivo confocal microscopy and the key differences between these devices are highlighted in this review. By providing a systematic review of the extensive literature on the human cornea, this perspective paper aims to provide an overview of how in vivo confocal microscopy has contributed to our greater understanding of the human cornea in health, in disease, and following surgery, with a particular emphasis on quantitative data. The utility and limitations of available data are highlighted as are possibilities for the future development of this innovative technology.

Corneal sensitivity and morphology of the corneal subbasal nerve plexus in primary congenital glaucoma

“…24 The enhanced image brightness and contrast of LSCM allows a qualitative evaluation of certain subtle features of the cornea. 25 Kobayashi et al 26 first reported the presence of microstructures (called K-structures) observed at the level of Bowman's layer in normal subjects with the aid of LSCM, which were not evident with slit scanning confocal microscopy, suggesting that LSCM offers considerably higher image quality compared with conventional white-light confocal microscopy.…”

Keratic precipitate morphology in uveitic syndromes including Behçet's disease as evaluated with in vivo confocal microscopy

“…5 However, the evaluation of KP with IVCM has been limited; the literature contains one report by Wertheim et al 2 in 2004 of findings in 33 patients with different forms of uveitis.…”

The Basics of Confocal Microscopy

“…Thus, confocal microscopy can serve as a valuable tool for live cell imaging. Clinically, CLSM is used in the evaluation of various eye diseases, and is particularly useful for imaging, qualitative analysis, and quantification of endothelial cells of the cornea (Patel and McGhee, 2007). It is used for localizing and identifying the presence of filamentary fungal elements in the corneal stroma in cases of keratomycosis, enabling rapid diagnosis and thereby early institution of definitive therapy.…”