Confocal microscopy in chronic and delayed mustard gas keratopathy.
OBJECTIVE
To evaluate in vivo confocal microscopic features of the cornea in chronic and delayed mustard gas keratopathy (MGK).


METHODS
Comparative cross-sectional study.


METHODS
Twenty-two eyes of 22 consecutive patients with MGK and 28 eyes of 28 normal unoperated subjects were enrolled.


METHODS
All subjects underwent corneal confocal scanning, and the findings were compared between the 2 groups.


METHODS
Qualitative (layer thickness measurement and cell count) and quantitative (nerve and deposit evaluation) findings of corneal confocal scanning.


RESULTS
All subjects with MGK and normal subjects were males, with no significant difference in mean age between the 2 groups. Mean central corneal thickness, mean epithelial thickness, mean cell density of basal epithelia, keratocyte density at 3 stromal layers, and endothelial cell density in the MGK group were significantly lower than those in the control group. Loss of keratocytes was predominantly observed in the anterior to middle stroma. In vivo confocal microscopy revealed lack of a subbasal nerve plexus, presence of intrastromal hyperreflective microdots, prominent thickened midstromal nerves, enlarged bizarre-looking keratocytes, amyloid degeneration, lipid keratopathy, posterior stromal folds, and endothelial cell pleomorphism and polymegathism.


CONCLUSIONS
Corneal thinning, significant loss of keratocytes together with pleomorphic residual keratocytes, thickened midstromal nerve, stromal microdots, amyloid degeneration, and lipid keratopathy were remarkable findings observed in our cases. Although all the corneal layers were affected significantly by mustard gas, the anterior to middle parts of the cornea were more involved than the posterior parts.
Jafarinasab
Mohammad-Reza
MR
Department of Ophthalmology, Labbafinejad Medical Center, Shaheed Beheshti University, Tehran, Iran.
Zarei-Ghanavati
Siamak
S
Kanavi
Mojgan Rezaei
MR
Karimian
Farid
F
Soroush
Mohammad-Reza
MR
Javadi
Mohammad-Ali
MA
D000328:Adult; D002057:Burns, Chemical / Q000473:pathology*; D002452:Cell Count; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D002908:Chronic Disease; D003316:Corneal Diseases / Q000139:chemically induced / Q000473:pathology*; D003430:Cross-Sectional Studies; D004728:Endothelium, Corneal / Q000187:drug effects / Q000473:pathology; D019573:Epithelium, Corneal / Q000187:drug effects / Q000473:pathology; D005126:Eye Burns / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D009151:Mustard Gas / Q000009:adverse effects*; D014857:Warfare
D002619:Chemical Warfare Agents; D009151:Mustard Gas