In Vivo Confocal Microscopy of Polymorphic Amyloid Degeneration and Posterior Crocodile Shagreen

Terrien's marginal degeneration accompanied by latticed stromal opacities

Purpose

We report a case of Terrien’s marginal degeneration (TMD) with a unilaterally typical narrow band of peripheral corneal stroma thinning, accompanied by the presence of an unusual network of opacities diffusing throughout the anterior stroma layers.

Case Report

A 43-year-old woman presented with superior nasal peripheral corneal thinning and an unusual network of polygonal stromal opacities in the anterior corneal stroma of the right eye. Latticed corneal changes were unusually extensive and distributed diffusely in the stroma. No abnormalities were found in the corneal epithelium and in the basal epithelial cells. No noticeable changes were found in the left eye. Because of a progressively worse ocular irritation of the right eye, a diagnosis of TMD was made for this patient.

Conclusions

This case of TMD accompanied by keratopathy was unusual. The branching stromal lattice pattern of the corneal opacities was difficult to distinguish from lattice corneal dystrophy. In this case, the polygonal stromal opacities were located in the anterior corneal stroma and therefore were distinguished from a similar manifestation in posterior crocodile shagreen.

Amyloid corneal deposition in corneal buttons of congenital hereditary endothelial dystrophy (CHED) - A clinical and histopathological case series

PURPOSE

To determine the frequency, pathology and clinical relevance of amyloid deposited in corneas of CHED.

METHODS

Clinical and histopathological case series.

RESULTS

Amyloid subepithelial deposition was found in 5 (6.6%) corneal buttons of 75 patients with histopathologically confirmed CHED diagnosis. Clinical findings included history of parental consanguinity, poor vision (ranging from counting fingers from one foot to 3/200), corneal edema, and central whitish subepithelial corneal nodules in all the five cases and positive family history in 4 of 5 cases. The patients underwent PKP at a mean age of 15 years (range 3-22 years). Histological findings included attenuated endothelium (6/6) thickened Descemet's membrane (6/6), stromal edema (2/6), and subepithelial amyloid deposits (6/6). All patients improved from vision point of view. To date, no recurrence of the amyloid has been seen in the grafts.

CONCLUSION

Considering the consanguinity, family history, early onset, and bilaterality, this study supports our hypothesis that the amyloid is primary in nature in our patients and indicates a new subtype of autosomal recessive CHED that require further chemical and genetic analysis. This subtype has the same prognosis for PKP as all CHED patients, if not better.

In Vivo Confocal Microscopy in Presumed Central Cloudy Dystrophy of François

A 70-years-old woman with no visual symptoms was incidentally diagnosed with presumed central cloudy dystrophy of François (CCDF) on regular ophthalmic examination. Bilateral polygonal opacities separated by clear spaces were seen in corneal biomicroscopic examination. The opacities were prominent in the central cornea and occupied full-thickness corneal stroma. Confocal microscopy revealed small highly refractile granules and deposits in the anterior and deeper stromal layers. Multiple dark acellular striae among extra-cellular matrices with increased intensities were seen in the posterior stroma. No stromal layer of keratocytes was observed. In the right eye, the corneal endothelial cell density was 3,319 cells/mm(2), polymegathism was 52.9%, and pleomorphism was 34.3%. In the left eye, endothelial cell counts could not be performed because of high stromal reflectance intensity. Full-thickness involvement of the corneal stroma with hyperreflective granules and microstriae and absence of keratocytes may represent a more advanced stage of the dystrophy.

Current applications of clinical confocal microscopy

PURPOSE OF REVIEW

Confocal microscopy's role within ophthalmology has been evolving since the introduction of this technology in 1955. The purpose of this review is to describe the confocal microscope and illustrate its recent ophthalmic applications.

RECENT FINDINGS

Numerous investigators have used confocal microscopy to research ophthalmic disease and to find new diagnostic applications. This review will describe the development and uses of this technology. The cornea was the first ophthalmic tissue to be imaged due to its transparency, although, tissues, such as conjunctiva, are now being studied. This article will review normal confocal corneal appearance and discuss a wide range of recent applications that include corneal infections, dystrophies and disease. Furthermore, this article will discuss recent developments in refractive surgery, ocular surgery and various miscellaneous discoveries.

SUMMARY

Confocal microscopy is developing into a powerful research and diagnostic tool in ophthalmology. The future uses of this novel technology will evolve and is increasingly becoming a vital tool in the ophthalmologist's armamentarium.