Corneal Confocal Microscopy in Patients with Vernal Keratoconjunctivitis

• Published in: Ophthalmology (Rochester, Minn.) Vol. 119; no. 3; pp. 509 - 515
• Main Authors: Leonardi, Andrea, MD, Lazzarini, Daniela, PhD, Bortolotti, Massimo, MD, Piliego, Federico, PhD, Midena, Edoardo, MD, Fregona, Iva, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Child, Preschool; Conjunctivitis, Allergic - diagnosis; Cornea - pathology; Corneal Stroma - innervation; Diseases of cornea, anterior segment and sclera; Epithelium, Corneal - pathology; Female; Humans; Male; Medical sciences; Microscopy, Confocal; Miscellaneous; Ophthalmology; Prospective Studies; Trigeminal Nerve - pathology; Young Adult; Human; Eye disease; Cornea; Keratoconjunctivitis; Confocal microscopy; Keratopathy; Conjunctiva disease; Ophthalmology; Anterior segment disease
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2011.09.018

Purpose To compare corneal morphologic features using in vivo confocal microscopy in vernal keratoconjunctivitis (VKC) patients compared with normal subjects. Design Prospective, comparative study. Participants Thirty-two VKC patients (26 males, 6 females; mean age, 17.1 years) and 40 normal subjects (20 males, 20 females; mean age, 19.3 years) were included. Methods All subjects underwent a full ophthalmologic examination. Confoscan CS4 (Nidek, Gamagori, Japan) images of the central cornea were obtained with a ×40 noncontact lens and Z-ring device. Main Outcome Measures The superficial and basal epithelium, subbasal nerve plexus, anterior stroma, stromal nerves, and endothelium of the central cornea were studied. Results The VKC patients had increased diameter, reflectivity, and presence of nuclear activation of superficial epithelial cells; reduced density of the basal membrane; lower density of keratocytes, increased presence of activated keratocytes, and inflammatory cells in the anterior stroma; and lower density and number of fibers, lower number of beadings, and higher grade of tortuosity of fibers in the subbasal nerve plexus. Increased alterations in thickness, deflections, and tortuosity were observed in stromal corneal nerves. An increased number of inflammatory cells in close proximity to the subbasal and stromal nerve fibers also was observed in VKC subjects. Conclusions Corneal involvement in VKC is associated with alterations of the epithelium and subbasal and stromal corneal nerves. These changes may relate to the tear dysfunction and nonspecific hyperreactivity typical of these patients. Corneal confocal microscopy is a useful tool for studying in vivo pathologic corneal changes in VKC. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.