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Olivia L Lee, Tudor C Tepelus, Srinivas R Sadda; Characterization of Corneal Involvement in Eyes with Mucous Membrane Pemphigoid by in vivo Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5461.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the morphological features of the corneal epithelial layers, sub-basal nerve plexus, stroma and endothelium in patients with pemphigoid by using in vivo confocal microscopy (IVCM).
Central cornea images were prospectively captured from 10 healthy control eyes and 10 eyes with clinically diagnosed mucous membrane pemphigoid using In Vivo Laser Scanning Confocal Microscopy (HRT III RCM). Morphological changes of the corneal epithelial layers, stroma, endothelium as well as sub-basal nerve density were evaluated.
Images obtained by IVCM from 20 eyes were analyzed. As compared to controls, eyes with pemphigoid displayed severe corneal changes, neovascularization and hyperreflective endothelial deposits. IVCM showed also corneal epithelial metaplasia, with hyperreflective enlarged cells, activated nuclei and decreased nucleus/cytoplasm ratio. Images of the sub-basal nerve plexus in pemphigoid demonstrate significant reduction in density or complete absence in severe cases. In some cases, the presence of conjunctival goblet cells on the corneal epithelium was noted.
IVCM reveals profound and significant microstructural changes in the central corneas of patients with pemphigoid as compared to controls. These features are consistent within the pemphigoid group, being proportional to the severity of the disease. Our findings suggest implications for use of IVCM in the evaluation and monitoring of patients with ocular manifestations of pemphigoid.
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