title: Correlation between clinical in vivo confocal microscopic and ex vivo histopathologic findings of Salzmann nodular degeneration.
abstract: OBJECTIVE
  To report clinical, in vivo confocal microscopy and ex vivo histopathologic findings of Salzmann nodular degeneration (SND).
  
  
  METHODS
  A 48-year-old woman with symptoms of ocular irritation and decreased visual acuity caused by SND in both eyes was treated by corneal scraping and phototherapeutic keratectomy (PTK). Slit-lamp biomicroscopy, in vivo confocal microscopy, ex vivo light microscopy, immunohistology, and corneal topography were performed.
  
  
  RESULTS
  In vivo confocal microscopy showed an irregular network of highly reflective structures representing activated keratocytes, which could be seen by light microscopy and characterized immunohistologically as myofibroblasts. Unstructured areas with increased reflectivity correlated with irregularly arranged collagen fibers and hyaline deposits in the nodulus. Epithelial cells in vivo appeared atypically shaped and elongated. These observations were consistent with decreased thickness of the epithelium over the nodules showed by histopathology. Treatment led to a dramatic reduction of hyperopia. Two months after surgery, uncorrected visual acuity (UCVA) in the right eye was 20/32 and 20/20 with a refraction of -0.75 -0.75/0 degrees. UCVA in the left eye was 20/40 and 20/20 with a refraction of +0.50 -1.75/165 degrees. Corneal topography showed regular astigmatism.
  
  
  CONCLUSIONS
  In vivo confocal microscopy confirmed the clinicopathologic findings of Salzmann's nodular degeneration. Observations by in vivo confocal microscopy were consistent with the histopathologic descriptions of SND.
authors.affiliation: Department of Ophthalmology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meltendorf
authors.forename: Jens
authors.initials: J
authors.lastname: Bühren
authors.forename: Reinhold
authors.initials: R
authors.lastname: Bug
authors.forename: Christian
authors.initials: C
authors.lastname: Ohrloff
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohnen
mesh_terms: D000199:Actins / Q000378:metabolism; D018952:Antigens, CD34 / Q000378:metabolism; D001251:Astigmatism / Q000209:etiology; D003317:Corneal Dystrophies, Hereditary / Q000150:complications / Q000473:pathology* / Q000601:surgery; D019781:Corneal Topography; D004847:Epithelial Cells / Q000378:metabolism / Q000473:pathology; D019573:Epithelium, Corneal / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology; D007124:Immunoenzyme Techniques; D054018:Lasers, Excimer; D018613:Microscopy, Confocal; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000199:Actins; D018952:Antigens, CD34