Corneal Disease by Thomas Reinhard & Frank Larkin

Author:Thomas Reinhard & Frank Larkin
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Corneal Surgery

IVCM was used in numerous studies to evaluate corneal wound healing following penetrating or lamellar keratoplasty, corneal cross-linking, or amniotic membrane transplantation.

As all corneal cells could be evaluated with IVCM, this technique is not only helpful for the preoperative evaluation of the cornea, but also for the follow-up of corneal changes after penetrating keratoplasty. Significant reductions in epithelial cell, keratocyte, nerve and endothelial cell densities were demonstrated with IVCM [14]. Interestingly, IVCM images of corneal allograft rejections revealed focal accumulations of hyper-reflective dendritic-like cells, presumably Langerhans cells, at the level of the basal epithelium and Bowman’s membrane associated with altered keratocytes and may be an interesting tool to aid in the diagnosis of early rejection [15].

More recently, IVCM has also been used to analyze the interface of deep lamellar keratoplasty, to compare different surgical techniques, and to measure the interface depth after anterior lamellar keratoplasty, or to evaluate the cornea after Descemet stripping endothelial keratoplasty (DSAEK) or Descemet stripping with automated endothelial keratoplasty (DSAEK).

IVCM can show directly photopolymerization effects and possible complications of corneal cross-linking. After the procedure, rarefaction of keratocytes in the anterior and intermediate stroma, and a stromal edema have been observed without endothelial cell damage. After 6 months, keratocyte population was normal and associated with an increased density of stromal fibers [16].

The observation of the morphology of transplanted amniotic membrane as well as its degradation is also possible with IVCM. The amniotic membrane stroma appears as a superficial dense fibrous layer and a deeper network of loosely arranged fibers.

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