Imre L., Tóth J., Nagymihály A.

Semmelweis Egyetem, Általános Orvostudományi Kar I. Szemészeti Klinika, Budapest. 1083 Tömo u.25-29

Objective: The aim of the study was to compare the tissue structure of normal and pathologic corneas by in vivo confocal microscopy (CM) and light microscopy (LM).
Methods: CM examinations were carried out with a 40x objective, magnification was 800x. Beside normal corneas the two method were compared in 8 cases of different corneal pathologies. Histologic preparations were from perforating keratoplasty specimens of patients who underwent surgery earlier. HE, PAS, colloid iron stains were used, magnification was 700x.
Results: We demonstrated correlation of CM and LM in perpendicular planes by correspondence of corneal layers in normal corneas In case of epithelial edema, the edema of the basal epithelial cells was clearly visible with both methods. Good correlation was also found in map-dot-fingerprint dystrophy. Cornea guttata was easily proved with CM, but with LM serial sections were sometimes needed. Advanced Fuchs dystrophy was recognized easily with both methods. In Reis-Bückler and granular dystrophy CM showed poorly defined highly reflective, unrecognizable structures, while with LM special stains made the diagnosis unequivocal. In acanthamoeba keratitis similar images were seen with both methods, showing corresponding pathognomic changes.
Conclusion: We demonstrated basic confocal microscopic findings in morphologically well-defined lesions of the cornea. In our opinion, CM is able to safely and easily identify relatively small changes in the cornea, even when located in a thin layer (basement membrane, endothelium). Differentiation of classic corneal dystrophies is difficult with CM.

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