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In Vivo Examination of the Corneal Stroma with the Digital-confocal Laser Scanning Microscope

1Knappe S., 1Sommer U., 2Eckard A., 1Stave J., 1Guthoff R.,
1Universität Rostock, Augenklinik (Rostock)
2Universität Rostock, Augenklinik, Station 1 (Rostock)

Introduction: The development of a confocal digital laser scanning microscope allows us for the first time to investigate the anterior segment in vivo with precise localisation of the observed structures. The main interest of our work applies to keratocytes and nerve fibers in the corneal stroma.
Method: Using a modified HRT II with a confocal laser scanning microscope the imaging level of the retina can be focused to the anterior segment in combination with an increasing resolution to approximatelly 600-fold. The system works with a contact system without applanation of the cornea. It permits a semiquantitative estimation of cell densities of the corneal epithelium, its innervation on height of the Bowman layer, of the keratocytes including the intercellular matrix, as well as structural components and blood vessels of the conjunctiva and sclera.
Results: We examined and compared the corneal stroma in different depths of healthy individuals (with a mean density of keratocytes of 15730/mm3 and a mean height of d=0,556 mm) and of patients with different corneal changes (e.g. keratokonus, corneal ulcers, keratoplasty, LASIK).
Conclusions: With that method we can demonstrate corneal structures in vivo And localize their depth exactly. Apart from keratocytes and nerve fibers also intercellular connections can be observed by the laser-scanning-microscopie in contrast to the slit-scanning-microscopy. Here and in the subepithelial nerve plexus significant changes can be seen for example after LASIK or keratoplasty. For a morphological identification of the observed structures an additional anatomical and biological cooperation is necessary. In further investigations we expect to recognice pathological changes earlier.