Confocal in vivo microscopy after 15 mm sclerocorneoplasty à chaud in necrotizing keratitis

Confocal microscopy allows an in-vivo visualization of corneal structures in frontal optical sections. By means of this method we show morphological changes in a corneal transplant after sclerocorneoplasty à chaud because of a necortizing keratitis. We report on a patient who had to undergo a 15 mm diameter sclerocorneoplasty à chaud because of a necrotizing keratitis of his right functionally last eye in October 1993. Five months after transplantation there was a circular vascularization of the scleral rim and a progressive crystalline deposition in the periphery of the cornea. The main part of the donor cornea remained clear with a vision of 0.6. After one year the patient had developed a mature complicated cataract and got a phacoemulsification with a tunnel in the transplanted cornea and an implantation of a posterior chamber lens. In May 1995 the visual acuity was 0.9. We examined the epithelium, stroma and endothelium of the graft by means of in-vivo confocal slit scanning microscopy. All layers of the cornea are demonstrated. There were crystalline needle-like structures in the peripheral stroma and round cystic bodies in the deep stroma. Nerves were visible one year after transplantation. The endothelial cells showed a mild polymorphism and still a density of 2200 cells/mm2. Confocal microscopy is a useful non invasive technique for routine examinations after keratoplasty. Microscopical changes in the tissue are also visible in case of absent postoperative complications. With growing knowledge the confocal microscopy will give more insight into processes of wound healing.