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H. M. Serra, J. Croxatto, T. A. Cafaro, F. Espósito, J. Holopainen, W. Neira-Zalentein, M. Fornies, J. Urrets-Zavalía; In vivo Corneal Confocal Microscopy Study in Climatic Droplet Keratopathy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5650.
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Climatic droplet keratopathy (CDK) is a degenerative disease of the cornea characterized by its slowly progressive opacity. A high prevalence of this disease has been found in a rural region of Argentine Patagonia. The aim of this study was to analyze corneal abnormalities in patients with CDK using in vivo confocal microscopy (CFM).
Three male patients with different grades of CDK underwent corneal studies including slit-lamp biomicroscopy, Cochet-Bonnet aesthesiometry and CFM. Axial images from different corneal layers as well as the peripheral and limbal areas were obtained.
Early stages showed reflective punctiform deposits in the basement membrane and Bowman’s layer. A diffuse mild back-scattered reflectivity was observed in the superficial stroma. The subepithelial nerve plexus was found to be normal. In moderate and advanced stages there was increased reflectivity of the surface corneal epithelium and condensation of the punctiform deposits. The deposits masked the subepithelial nerve plexus. At these stages hyperreflective round deposits were seen within the anterior stroma. The stromal nerves were abnormal. In later stages, there were subepithelial stromal hyperreflective plaques, activated keratocytes and peripheral vascularization, and the nerves were markedly reduced. Corneal sensitivity correlated well with corneal compromise because the more advanced the disease, the more profound the corneal hypoesthesia.
CFM showed a progression of anterior cornea subepithelial and stromal deposits from early to advanced stages of CDK. Progressive damage of the sub-basal and stromal nerves fibers may lead to changes in corneal sensitivity.
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