title: In VivoConfocal Microscopic Architecture of Corneal Nerves in a Case of Multiple Endocrine Neoplasia Type 2b.
abstract: A detailed ocular examination andin vivoconfocal microscopy (IVCM) using the Heidelberg retinal tomograph 3 with Rostock cornea module were performed in a patient with multiple endocrine neoplasia (MEN) 2b syndrome. Ocular findings included ptosis secondary to thickening of the lid margins, subconjunctival and perilimbal neuromas, and prominent corneal nerves extending up to the pupillary area. IVCM demonstrated structural alterations of both the main nerve trunks and the smaller branches. The main nerve trunks were grossly thickened while the smaller fibers were present in an intertwining manner in the anterior stroma. Some fibers showed prominent looping and nodular dilatations at irregular intervals along the length of the nerves. These nodular dilatations were in all probability ganglioneuromas of corneal nerves demonstrated by histopathology in earlier reports of MEN 2b. IVCM may be potentially useful in detecting the nerve alterations in MEN 2b even before other ocular or systemic features become apparent clinically.
authors.affiliation: Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Chintan
authors.initials: C
authors.lastname: Malhotra
authors.affiliation: Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Arun Kumar
authors.initials: AK
authors.lastname: Jain
authors.affiliation: Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Bikram
authors.initials: B
authors.lastname: Thapa
authors.affiliation: Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sabin
authors.initials: S
authors.lastname: Sahu
mesh_terms: D000328:Adult; D003230:Conjunctival Neoplasms / Q000000981:diagnostic imaging*; D003315:Cornea / Q000294:innervation*; D005141:Eyelid Diseases / Q000175:diagnosis; D005729:Ganglioneuroma / Q000000981:diagnostic imaging*; D006801:Humans; D016850:Limbus Corneae / Q000473:pathology*; D008297:Male; D018613:Microscopy, Confocal; D018814:Multiple Endocrine Neoplasia Type 2b / Q000000981:diagnostic imaging*; D020433:Trigeminal Nerve Diseases / Q000000981:diagnostic imaging*
keywords: Corneal Nerves; In Vivo Confocal Microscopy; Multiple Endocrine Neoplasia