title: Corneal nerve aberrations in bullous keratopathy.
abstract: OBJECTIVE
  To study the corneal nerves in patients with chronic bullous keratopathy.
  
  
  METHODS
  Prospective observational case series with histologic evaluation.
  
  
  METHODS
  We studied 25 eyes of 25 bullous keratopathy patients of different etiologies (17 female, 8 male; mean age, 76.3 years) as well as 6 eyes of 6 normal control subjects (5 male, 1 female; mean age, 38 years). All subjects were scanned by laser scanning confocal microscope. Five corneal buttons obtained following penetrating keratoplasty from 5 of the above patients and 6 normal control corneal buttons were stained as whole mounts with acetylcholinesterase (AChE) method for corneal nerve demonstration and scanned in multiple layers with digital pathology scanning microscope.
  
  
  RESULTS
  The density, branching pattern, and diameter of sub-basal nerves were significantly lower in corneas with bullous keratopathy compared with normal corneas (density: 4.42 ± 1.91 mm/mm(2) vs 20.05 ± 4.24 mm/mm(2); branching pattern: 36.02% ± 26.57% vs 70.79% ± 10.53%; diameter: 3.07 ± 0.64 μm vs 4.57 ± 1.12 μm). Aberrations such as localized thickenings or excrescences, abnormal twisting, coiling, and looping of the (mid) stromal nerves were observed in the study group both by in vivo confocal microscopy and on histology.
  
  
  CONCLUSIONS
  Striking alterations in corneal innervation are present in corneas with bullous keratopathy that are unrelated to any specific etiology of bullous keratopathy. This study provides histologic confirmation of novel in vivo confocal microscopy findings related to corneal nerves in bullous keratopathy.
authors.affiliation: School of Clinical Sciences, Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Mouhamed
authors.initials: M
authors.lastname: Al-Aqaba
authors.forename: Thaer
authors.initials: T
authors.lastname: Alomar
authors.forename: James
authors.initials: J
authors.lastname: Lowe
authors.forename: Harminder S
authors.initials: HS
authors.lastname: Dua
mesh_terms: D000110:Acetylcholinesterase; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000175:diagnosis* / Q000601:surgery; D003316:Corneal Diseases / Q000175:diagnosis* / Q000601:surgery; D003319:Corneal Stroma / Q000294:innervation*; D003389:Cranial Nerve Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009882:Ophthalmic Nerve / Q000473:pathology*; D011446:Prospective Studies; D013194:Staining and Labeling / Q000379:methods
chemical_list: D000110:Acetylcholinesterase