title: Histological and confocal microscopy changes in chronic corneal edema: implications for endothelial transplantation.
abstract: OBJECTIVE
  To report in vivo confocal microscopic (IVCM) features in corneal edema supported by histopathologic correlation.
  
  
  METHODS
  This was an observational study with evaluation of diagnostic technology. Twenty patients with clinically diagnosed corneal edema were involved, including 11 with Fuchs' endothelial dystrophy (FED). All cases, in addition to a control group of six normal eyes, were examined with IVCM before keratoplasty. Four eyes were examined after surgery. Thirteen corneal samples obtained by penetrating keratoplasty were examined by light and/or electron microscopy. IVCM and histopathologic sections were then analyzed for correlation and proper interpretation. Seven patients underwent Descemet's stripping endothelial keratoplasty (DSEK).
  
  
  RESULTS
  Subepithelial fibroblasts were seen histologically and with IVCM in 7 (53.8%) of 13 full-thickness corneal samples. IVCM alone detected these changes in 11 (55%) subjects before surgery, as well as after postoperative clinical improvement. Other IVCM features included absent (30%) or reduced (70%) subbasal corneal nerves, expanded hyperreflective keratocyte cell bodies, and processes with small vacuoles and large extracellular lacunae (95%), seen on IVCM only. Endothelial changes with polymegathism and reduced cell density were seen in non-FED cases.
  
  
  CONCLUSIONS
  This is the first study in which IVCM features of corneal edema have been compared in detail with histopathologic findings. Subepithelial fibroblasts, reduced subbasal corneal nerves, and stromal keratocyte morphology were well documented in this study. With increasing popularity of DSEK this work supports the role of IVCM in quantitative evaluation of corneal edema in early preoperative stages, as well as after surgery, when the cornea appear clinically, but not histologically, normal.
authors: Division of Ophthalmology and Visual Sciences, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom.
authors: Thaer S
authors: TS
authors: Alomar
authors: Mouhamed
authors: M
authors: Al-Aqaba
authors: Trevor
authors: T
authors: Gray
authors: James
authors: J
authors: Lowe
authors: Harminder S
authors: HS
authors: Dua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D048430:Cell Shape; D002908:Chronic Disease; D003315:Cornea / Q000294:innervation / Q000648:ultrastructure*; D015715:Corneal Edema / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D005347:Fibroblasts / Q000473:pathology; D005642:Fuchs' Endothelial Dystrophy / Q000473:pathology* / Q000601:surgery; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D018613:Microscopy, Confocal; D008854:Microscopy, Electron; D008875:Middle Aged; D020433:Trigeminal Nerve Diseases / Q000473:pathology; D014786:Vision Disorders / Q000175:diagnosis; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult