In vivo confocal microscopy of the ocular surface: from bench to bedside and back again

Major clinical applications of CM include ocular surface changes starting with dry eye, changes in corneal sensation and wound healing mechanisms after refractive surgery or corneal grafting, 12 13 stromal changes including so-called activated keratocytes after cross-linking 14 and imaging of filtering blebs after glaucoma surgery. 15 16 In a paper published in this issue (see page 1592 ), Mastropasqua et al present the results of an in vivo analysis of conjunctiva following gold micro-shunt implantation for glaucoma. 17 Previous studies have analysed the bleb microstructures that are invisible under a slit lamp in order to evaluate bleb function. [...]the number of epithelial microcysts, a large total stromal cyst area, the absence of encapsulated stromal cysts, minimal vascularisation and the absence of tortuous conjunctival vessels are associated with good bleb function. 15 16 While subepithelial connective tissue is widely spaced in functioning blebs, it tends to be dense in non-functioning blebs. 18 In the current study, Mastropasqua et al state that successful shunt implantation significantly increases conjunctival microcyst density and surface at the site of device insertion.