Correlation of the Appearance of the Keratoconic Cornea In Vivo by Confocal Microscopy and In Vitro by Light Microscopy

Abstract

The current study confirms the application of CM for assessing morphologic alterations to the epithelium, Bowman's layer, and stroma in keratoconus. Many of the tissue changes observed with CM could be reconciled with observations made using LM. This work provides a framework against which tissue changes in keratoconus can be studied in a clinical context in vivo using CM.

Quantitative analysis of corneal microstructure in keratoconus utilising in vivo confocal microscopy

“…2 In our study there was a reduction in basal epithelium density within the keratoconic corneas. Hollingsworth et al 19,20 also demonstrated this reduction and found similar difficulties in obtaining consistent imaging of the superficial epithelial layers. These authors also reported evidence of epithelial elongation, although this was not seen in our study this could be due to differences in experimental methodology.…”

“…One important difference between the two studies previously commented on is the corneal location examined (central cornea 19,20 vs corneal apex). Keratocyte cell density may not be uniform across the keratoconic cornea and this may explain the higher anterior and posterior keratocyte densities reported in our study.…”

“…These authors also reported evidence of epithelial elongation, although this was not seen in our study this could be due to differences in experimental methodology. Hollingsworth et al 19,20 imaged the central cornea while our study examined the corneal apex (except in three cases where stromal scarring prevented good visualisation at the apex).…”

“…In a very recent series of in vivo confocal microscopy studies, Hollingsworth et al 8,19,20,46 have provided novel data with which the current study can be compared. One important difference between the two studies previously commented on is the corneal location examined (central cornea 19,20 vs corneal apex).…”

Corneal Cell Morphology in Keratoconus: A Confocal Microscopic Observation

“…Recently, Bitirgen et al observed a significant difference in the keratocyte density between mild and moderate keratoconus (22). Studies showed that keratocyte cell loss could be associated with the release of cytokines in the pathological process of the disease that causes the apoptosis of keratocyte (23,24). However, mechanical injuries in the epithelium due to eye rubbing or wearing of contact lenses could also lead to the release of apoptotic cytokines (25,26).…”