In vivo confocal microscopy in primary congenital glaucoma with megalocornea.
OBJECTIVE
To report the microscopic findings of congenital glaucoma-related megalocornea using in vivo confocal microscopy.


METHODS
Two consecutive adult patients presenting the typical features of glaucomatous megalocornea underwent a complete ophthalmologic examination. The first patient presented with progressive glaucoma with bilateral megalocornea. The second patient's left eye was affected by megalocornea without actual evidence of glaucoma, whereas the right eye was healthy. Both patients were examined using a new-generation scanning slit corneal confocal microscope.


RESULTS
In both patients, confocal microscopy revealed a mild reduction of keratocyte density in the mid and rear stroma, a particular abnormal "clew-shaped" morphology of stromal nerves, and the presence of discontinuous hyperreflective structures overhanging the endothelial layer at the level of the Descemet membrane. The endothelium showed severe polymegethism, pleomorphism, and a markedly decreased cell density, and focal cellular lesions were noted.


CONCLUSIONS
Confocal microscopy is a diagnostic tool used to evaluate microscopic aspects of Haab striae and endothelial morphologic changes in glaucomatous megalocornea. Unsuspected alterations, such as nerves abnormalities and focal endothelial tractions by scar tissue, were observed.
Mastropasqua
Leornardo
L
Institute of Ophthalmology and Legal Medicine, University G. D'Annunzio, Chieti, Italy. mastropa@phobos.unich.it
Carpineto
Paolo
P
Ciancaglini
Marco
M
Nubile
Mario
M
Doronzo
Emanuele
E
D000328:Adult; D002452:Cell Count; D003315:Cornea / Q000002:abnormalities* / Q000294:innervation; D003319:Corneal Stroma / Q000294:innervation / Q000473:pathology; D004728:Endothelium, Corneal / Q000473:pathology; D005124:Eye Abnormalities / Q000175:diagnosis*; D005260:Female; D005347:Fibroblasts / Q000473:pathology; D005901:Glaucoma / Q000151:congenital* / Q000473:pathology; D006801:Humans; D018613:Microscopy, Confocal; D008875:Middle Aged; D014276:Trigeminal Nerve / Q000473:pathology