Gaia Ceresara

Corneal Subbasal Nerves Changes in Patients with Diabetic Retinopathy: An In Vivo Confocal Study

PURPOSE To study the subbasal corneal plexus (SCP) in patients with diabetic retinopathy (DR) treated or nontreated with panretinal Argon laser photocoagulation (ALP). METHOD Fifty consecutive patients with DR and 50 age- and sex-matched normal control subjects were examined with retinal tomography by a masked evaluator. The following subbasal plexus nerves parameters were considered: number per frame, tortuosity, and reflectivity. Diabetic patients were divided into two groups, according to the presence of proliferative versus nonproliferative retinopathy, according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification. RESULTS The number of fibers per frame and reflectivity were significantly lower in diabetic patients compared with control subjects (2.4 +/- 1 vs. 2.9 +/- 0.8, P = 0.01 and 2.3 +/- 0.9 vs. 2.6 +/- 0.9, P = 0.04, respectively). Tortuosity was significantly higher in diabetic patients (2.5 +/- 0.9 vs. 2.0 +/- 0.8, P = 0.002). Number per frame and reflectivity were significantly lower in diabetic patients with proliferative diabetic retinopathy (PDR; respectively, 2.0 +/- 0.9 vs. 2.9 +/- 0.9, P = 0.001, and 2.0 +/- 0.8 vs. 2.6 +/- 0.7, P = 0.003). Tortuosity was significantly higher in the PDR group (2.2 +/- 0.8 vs. 2.8 +/- 0.9, P = 0.008). The PDR group treated with ALP had significantly lower subbasal nerves number compared with the nontreated group (P = 0.01). CONCLUSIONS DR may induce substantial changes in the SCP. There is a difference between proliferative and nonproliferative retinopathy and in the former group between ALP treated and nontreated patients.

Corneal Involvement in Uneventful Cataract Surgery: An in vivo Confocal Microscopy Study

Purpose: To evaluate corneal subbasal layer changes after uneventful cataract surgery by means of in vivo confocal microscopy. Methods: This prospective study included 30 patients. Before surgery, and 1, 3, 6, 8 and 10 months after cataract surgery, all patients underwent a complete ophthalmological and confocal microscopy examination in the central and temporal corneal areas. Number of fibers, beading, tortuosity and reflectivity were analyzed. Results: Important changes were shown in the central cornea up to 3 months after surgery: a reduction in nerve fiber number (baseline: 4.4 ± 1.7; month 1: 1.2 ± 0.5, p < 0.0001; month 3: 2.5 ± 1.2, p < 0.005) and reflectivity (baseline: 3.6 ± 0.5; month 1: 1.4 ± 0.6, p < 0.0001; month 3: 1.9 ± 0.9, p < 0. 0001), and an increase in beading (baseline: 0.3 ± 0.5 beads/100 µm2; month 1: 2.7 ± 0.6 beads/100 µm2, p < 0.0001; month 3: 2.6 ± 0.5 beads/100 µm2, p < 0. 0001). The confocal parameters completely progressively recovered thereafter (60% at 6 months, 87% at 8 and 10 months). The temporal plexus was absent at 1 month and fully recovered in all patients at month 8. Conclusion: Uneventful cataract surgery induces relevant corneal modifications when inspected by means of confocal microscopy.

Corneal involvement in Wilson's disease : an in vivo confocal microscopy study

Purpose: To evaluate the corneal changes of patients with Crohns disease (CD) using confocal microscopy and to investigate the association among confocal parameters and CD activity and CD treatment. Methods: Thirty consecutive patients (age: 42 ± 12 years; 19 women and 11 men) affected by CD and 30 control eyes (age matched and gender matched) underwent an ophthalmic examination and, in 1 eye chosen at random, confocal microscopy of the central cornea using the cornea module of Heidelberg Retina Tomograph. The following confocal parameters were evaluated: density of basal epithelial cells, epithelial dendritic cells, anterior and posterior stromal keratocytes, and endothelial cells; the subbasal plexus was assessed for number and tortuosity of the nerve fibers. Results: Routine ophthalmic evaluation was normal in the whole population. At confocal microscopy, 40% of patients with CD had hyperreflective dots in the basal epithelium, which were absent in the control group. Activation of keratocytes was found in 86.6% of patients with CD and was absent in the control group. Compared with controls, patients with CD had lower density of dendritic cells (12.2 ± 26.3 vs. 50.3 ± 37.6 cells per square millimeter; P = 0.001). The other confocal parameters were similar in the 2 groups. No correlation between CD activity index and confocal changes was found. Conclusion: Confocal microscopy can detect subtle corneal changes in patients with CD, which may be signs of subclinical inflammation.

In vivo confocal microscopy in Terrien marginal corneal degeneration: a case report.

Purpose: To report an advanced case of Terrien marginal corneal degeneration (TMD) analyzed by means of confocal microscopy. Methods: A 62-year-old woman with TMD underwent a routine ophthalmological examination and was evaluated for the disease by using in vivo laser scanning confocal microscopy with the Heidelberg Retina Tomograph 2 Rostock Cornea Module. Results: The slit-lamp examination of the right eye showed an upper peripheral cornea thinning associated with a deposition of refractile yellow-white materials in the anterior stroma. Superficial radial vessels in the upper peripheral cornea were the only pathological findings of the left eye. Confocal microscopy of the right eye lesion showed deposition of hyperreflective material, and the stroma below presented a honeycomb-like pattern. Inflammatory cell infiltration, abnormal subbasal nerve plexus, epithelial basal membrane defects, irregular Bowman membrane, and the presence of activated keratocytes were observed in the cornea of both eyes. Conclusions: In vivo confocal microscopy can detect subtle corneal changes in an advanced case of TMD, which may be signs of subclinical inflammation.

The effects of topical coenzyme Q10 and vitamin E D-α-tocopheryl polyethylene glycol 1000 succinate after cataract surgery: a clinical and in vivo confocal study.

Purpose: To evaluate the postoperative effects of topical coenzyme Q10 + vitamin E d-α-tocopheryl polyethylene glycol 1000 succinate (CoQ10) after cataract surgery. Methods: 40 consecutive patients were randomized to receive CoQ10 or saline solution (SS) twice daily for 9 months after uneventful cataract surgery with a temporal port. Before surgery, on day 14 and at months 3, 6 and 9, they underwent non-invasive break-up time (NIBUT) testing, Schirmer test, BUT, aesthesiometry as well as in vivo confocal microscopy of the subbasal nerve plexus of the cornea (SBP). The density of the subbasal nerves was calculated in the central (CFD) and temporal (TFD) cornea (number of fibres per field). Results: On day 14, surgery reduced CFD and TFD, respectively, by 25–35 and 50%; indices of ocular surface stability were all impaired. The treatment with CoQ10 was associated with faster nerve regeneration than SS (at month 3, CFD +1.5 ± 1.9 vs. +0.2 ± 1.8, p = 0.04, and TFD +2.5 ± 1.7 vs. +1.0 ± 1.6, p = 0.007; at month 6, TFD +2.7 ± 1.9 vs. +1.4 ± 1.5, p = 0.02) and better stability of ocular surface (NIBUT and BUT) throughout the study. No relevant side effects were found, apart from occasional burning in 10% of CoQ10 patients. Conclusions: Changes of the corneal nerves occurring after cataract surgery may influence the integrity of the ocular surface. Treatment with topical CoQ10 has a positive effect in restoring SBP anatomy and ocular surface stability.

Study of corneal copper deposits in Wilson's disease by in vivo confocal microscopy.

Purpose: To study corneal copper deposits in Wilsons disease (WD) patients by traditional biomicroscopy and in vivo laser scanning confocal microscopy (LSCM). Methods: Twenty WD patients and 20 matched controls underwent an ophthalmic examination in one eye randomly chosen, including slit lamp biomicroscopy with Goldmanns three-mirror contact lens examination and LSCM, in order to evaluate copper deposits in the peripheral cornea. Results: No control subjects had corneal changes at both traditional biomicroscopy and LSCM. Only 25% of WD patients had detectable slit lamp changes, compared with 75% with LSCM examination. All cases detected by slit lamp were detected by LSCM. A significant correlation (p < 0.01) was found between deposit intensity at LSCM and daily urinary copper excretion. Conclusion: LSCM could detect copper deposition in WD corneas in more patients than traditional examination; it may therefore provide important information in cases of suspected WD diagnosis.