Update on Corneal Confocal Microscopy Imaging

Abstract

In vivo corneal confocal microscopy (IVCM) is a non-invasive ophthalmic imaging technique that provides images of the cornea at the cellular level. Despite the uses in ocular surface pathologies, in the last decades IVCM has been used to provide more knowledge in refractive surgery wound healing, in neuropathies diagnosis, etc. The observation of the corneal cells, both normal and inflammatory, and the possibility of quantification of the corneal nerve density with manual or automated tools, makes IVCM have a significant potential to improve the diagnosis and prognosis in several systemic and corneal conditions.

Keywords: corneal confocal microscopy; corneal pathology; dry eye disease; in vivo images; neuropathy.

Figure 1

Basal epithelial cells of a human cornea observed with the corneal confocal microscopy HRT II.

Figure 2

Sub-basal corneal nerves of a human cornea observed with corneal confocal microscopy, using the HRT II.

Figure 3

Corneal stroma of a human cornea observed with the confocal corneal microscopy HRTII.

Figure 4

Postoperative haze after laser-assisted subepithelial keratectomy (LASEK).

Figure 5

Sub-basal nerve plexus in LASIK patient. In red is marked a main corneal nerve, and in pink are marked secondary corneal nerves with ramifications.

Figure 6

Laser confocal microscopic images of Acanthamoeba cysts. In image (A), the cysts show a highly reflective nucleus surrounded by a low-refractile ring wall (white arrows). The central structure is regular and round with uniform reflection. In image (B) we also see a hyperreflective scar (black arrow).

Figure 7

Image of IVCM of dendritic cells. In white circles are shown some of the active DCs.

Figure 8

(A) Corneal nerve plexus in a patient without systemic pathologies and without refractive surgery. (B,C) Corneal nerve plexus in right eye and left eye of a patient with small fiber neuropathy.

Figure 9

Neuromas in long COVID-19 patient seen with IVCM, white arrows.