[The alterations in corneal structure at III/IV stage of keratoconus by means of confocal microscopy and ultrasound biomicroscopy before penetrating keratoplasty].
OBJECTIVE
The aim of the study was in-real time observation and morphological evaluation of the human corneas at III/IV stage of keratoconus, using the scanning slit confocal microscope Confoscan P4 and ultrasound biomicroscopy--UBM.


METHODS
The patients with keratoconus were examined according to the Amsler scale. The material consisted of 12 corneas of 11 patients (8 men, 3 women), where assessment of the corneal structure was performed with the confocal microscope ConfoScan P4 (Tomey) and ultrasound biomicroscopy--UBM Model 840 (Humphrey Instruments). The comparison of different corneal regions (central and peripheral) was evaluated.


RESULTS
The confocal microscopy and UBM revealed thinning of the layers of the corneal structure and pathological changes in the central area, especially at IV stage of keratoconus. The desquamating superficial cells were elongated, arranged around the apex of the cornea. Below the Bowman's membrane a considerable disarrangement of collagen fibers reflected by bright background illumination was observed. In the posterior part of the stroma the folds were detected. The examination of the cornea showed thickening in the peripheral part, central detachment of the Descemet's membrane and the endothelium from the posterior surface of the cornea. The thickness of the cornea varied from 0.201 to 0.384 mm in the central part and 0.675 to 0.740 mm in the peripheral area.


CONCLUSIONS
Confocal scanning microscopy combined with ultrasound biomicroscopy enables the cornea to be examined in vivo. It can be used to localize pathological changes in individual corneal layers and to assess their extent.
Wygledowska-Promieńska
D
D
I Katedry i Kliniki Okulistyki Slaskiej AM w Katowicach.
Rokita-Wala
I
I
Gierek-Ciaciura
S
S
Piatek-Koronowska
G
G
D000293:Adolescent; D000328:Adult; D003315:Cornea / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008853:Microscopy / Q000379:methods; D018613:Microscopy, Confocal / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography