In Vivo Confocal Microscopy of the Human Cornea in the Assessment of Peripheral Neuropathy and Systemic Diseases

Abstract

In vivo confocal microscopy (IVCM) of the living human cornea offers the ability to perform repeated imaging without tissue damage. Studies using corneal IVCM have led to significant contributions to scientific and clinical knowledge of the living cornea in health and pathological states. Recently the application of corneal IVCM beyond ophthalmology to wider clinical and research fields has been demonstrated. Abnormalities of the corneal subbasal nerve plexus have been associated with many forms of peripheral neuropathy and Langerhans cells correlate with systemic inflammatory states. There is a rapidly growing evidence base investigating the use of corneal IVCM in many systemic conditions and a well-established evidence base for IVCM imaging of the corneal subbasal plexus in diabetic peripheral neuropathy. This paper reviews the potential use of corneal IVCM in general clinical practice as a noninvasive method of assessing peripheral neuropathies, monitoring inflammatory states and clinical therapeutic response.

Figure 1

In vivo confocal microscopy images showing the normal corneal basal epithelium (a), central corneal subbasal plexus (b), and stroma (c) from a healthy 24-year-old female.

Figure 2

In vivo confocal microscopy images showing the corneal subbasal plexus of a 33-year-old female with a 14-year history of type 1 diabetes (a) and a healthy 32-year-old healthy female (frame size represents 400 μm × 400 μm).

Figure 3

In vivo confocal microscopy image at the level of Bowman's layer showing Langerhans cells (arrow) (frame size represents 400 μm × 400 μm).

Figure 4

In vivo confocal microscopy image of the central corneal subbasal plexus of a 72-year-old male who completed nine courses of oxaliplatin chemotherapy, showing a low subbasal nerve density (frame size represents 400 μm × 400 μm).