The Use of Confocal Corneal Microscopy in the Cogan Microcystic Dystrophy Diagnosis and follow – up of the Ultrastructural Changes after Phototherapeutic Keratectomy
Authors:
L. Pirnerová; E. Vlková; M. Horáčková; Z. Hlinomazová; V. Trnková
Authors place of work:
Oční klinika Lékařské fakulty MU a Fakultní nemocnice, Brno, přednosta prof. MUDr. Eva Vlková, CSc.
Published in the journal:
Čes. a slov. Oftal., 67, 2011, No. 3, p. 81-84
Category:
Original Article
Summary
Confocal microscopy represents modern, non-invasive, semi-contact examination method making possible to visualize separate corneal layers (from the endothel to the epithel) in high resolution. Phototherapeutic keratectomy (PTK) is a method using argon-fluoride laser with 193 nm wavelength to treat corneal surface diseases.
Aim:
To evaluate the use of confocal microscopy for epithelial basal membrane dystrophy diagnosis (Cogan microcystic dystrophy) and following corneal ultra-structural changes in vivo after PTK.
Material and methods:
The group consisted of 14 eyes of 9 patients (6 men and 3 women) of average age 45.8 ± 14.4 years who underwent in the department in last two years phototherapeutic keratectomy for recurrent erosion in Cogan microcystic corneal dystrophy. For the diagnosis of this disease, the confocal corneal microscope (Confoscan 4, Nidek, probe x 40) was used. Computer controlled laser photoablation was in all patients performed; the average depth was 14.8 ± 3.3 μm (Technolas 217, Bausch & Lomb). The follow-up visits were scheduled always day 5 and 12, and month 1, 3, 6, and 12 after the PTK. The reactive processes in all corneal layers, the subepithelial inervation restoration velocity and recurrence of the primary disease detectable by means of the confocal corneal microscope were followed-up.
Results:
Cogan microcystic dystrophy was diagnosed in all followed-up patients by means of confocal microscope according to the findings of the area thickening and corneal epithelium basal membrane irregularities. These patients were indicated to the PTK. After the treatment, the healing of the epithelial layer was finished as early as the fifth day. The subepithelial nervous plexus average regeneration period was 6.2 ± 2.8 months. In all patients, the edema of the anterior stroma was found at the day 5. The beginning of the re-popularization of the anterior stroma by keratocytes from deeper layers we diagnosed, on average, at the day 11.5 ± 1.9 after the treatment and the following reduction after 5.1 ± 1.4 months. In the posterior stroma and in the endothel, no changes were found. During the follow – up period, in none of the followed – up patients, the recurrence of the primary disease was found.
Conclusion:
The confocal microscopy may be recommended for superficial corneal dystrophies quality and accurate diagnosis and to follow up changes after phototherapeutic keratectomy as suitable treatment method of these diseases.
Key words:
confocal corneal microscopy, Cogan microcystic dystrophy, phototherapeutic keratectomy, excimer laser
Zdroje
1. Cavanaugh, T.B., Lind, D.M., Cutarelli, P.E., et al.: Phototherapeutic keratectomy for recurrent erosion syndrome in anterior basement membrane dystrophy. Ophthalmology, 1999; 106: 971–976.
2. Dausch, D., Landesz, M., Klein, R., et al.: Phototherapeutic keratectomy in recurrent corneal epithelial erosion. J Refract Corn Surg, 1993; 9: 419–424.
3. Dinh, R., Rapuano, C.J., Cohen,E.J. et al.: Recurrence of corneal dystrophy after excimer laser phototherapeutic keratectomy. Ophthalmology, 1999, 106; 8: 1490–1497.
4. Dupas, B., Labbé, A., Auclin, F., et al.: Epithelial Basement Membrane Dystrophy: An Evaluation With a New in vivo Confocal Microscope. IOVS. 2005; 46: 4926-B-125.
5. Fagerholm, P.: Phototherapeutic keratectomy. 12 years of experience. Acta Ophthalmol Scand, 2003; 81: 19–32.
6. Frederick, S., McDonnell, B.P.J., McGhee Ch. N. J.: Corneal surgery: theory, technique and tissue, 4. vydání, Mosby Elsevier, 2009, s. 100, ISBN 13: 978-0-323-04835-4.
7. Frueh, B.E., Cadez, R., Bonke, M.: In vivo confocal microscopy after photorefractive keratectomy in humans. A prospective, long-term study. 1998; 116: 1425–1431.
8. Germundsson, J., Fagerholm, P., Lagali, N.: Clinical Outcome and Recurrence of Epithelial Basement Membrane Dystrophy after Phototherapeutic Keratectomy. A Cross-sectional Study. Ophthalmology, 2011; 3: 515–522.
9. Hernández-Quintela, E., Mayer, F., Dighiero, P. et al.: Confocal microscopy of cystic disorders of the corneal epithelium. Ophthalmology, 1998, 105; 4: 631–636.
10. Ho, C.L., Tan, D.T., Chan, W.K.: Excimer laser phototherapeutic keratectomy for recurrent corneal erosions. Ann Acad Med Singapore, 1999; 28: 787–790.
11. Kuchyňka, P.a kol.: Oční lékařství. Grada publishing, a.s., 2007, 219. ISBN 978-80-247-1163–1168.
12. Labbé, A., De Nicola, R., Dupas, B., Auclin F, et al.: Epithelial basement membrane dystrophy: Evaluation with the HRT II Rostock Cornea Module. Ophthalmology, 2006; 113: 1301–1308.
13. Lagali, N., Germundsson, J., Fagerholm, P.: The role of Bowman‘s layer in corneal regeneration after phototherapeutic keratectomy: A prospective study using in vivo confocal microscopy. IOVS. 2009, 50; 9: 4192–4198.
14. Linna, T., Tervo, T.: Real-time confocal microscopic observations on human corneal nerves and wound healing after excimer laser photorefractive keratectomy. Curr Eye Res. 1997, 16; 7: 640–649.
15. Mastropasqua, L., Nubile, M.: Confocal microscopy of the cornea. SLACK Incorporated, 2002, s.1,2, ISBN 1-55642-611-9.
16. Mrukwa-Kominek, E., Gierek-Ciaciura, S.: Application of Confocal Microscopy. Cataract Refract Surg Today Europe, May 2007, 36–38.
17. MŅller-Pedersen, T., Li, H.F., Petroll, W.M. et al.: Confocal microscopic characterization of wound healing after photorefractive keratectomy. IOVS. 1998, 39: 487–501.
18. Rosenberg, M.E., Tervo, T.M., Petroll, W.M. et al.: In vivo confocal microscopy of patients with corneal recurrent erosion syndrome or epithelial basement membrane dystrophy. Ophthalmology, 2000; 107: 565–573.
19. Verdie, D.: Dystrophy, Map-dot-fingerprint, eMedicine 2009 http://emedicine. medscape.com/article/1193945-dia gnosis.
20. Yanoff.,M.,Duker,J.S., Edginton, B., Goldstein, M.H. et al.: Ophthalmology (third edition). Mosby Elsevier, 2009, 303–304, ISBN 978-0-323-04332-8.
Štítky
OphthalmologyČlánok vyšiel v časopise
Czech and Slovak Ophthalmology
2011 Číslo 3
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