Abstract
Abstract: :
Purpose: To evaluate applications of a computerized confocal optical microscopy system( Confoscan 2.0 by Nidek), in classical Cogan's Syndrome (CS), i.e. interstitial keratitis and sensorineural hearing loss. Patients and methods: 5 patients have been studied: 4 adults with a previous diagnosis of Cogan's Syndrome ( 3 presenting the classical form and one the atypical form of the disease) and one child with "atypical" corneal lesions and a suspicion of Cogan's Syndrome. Confoscan 2.0 provided in vivo highly detailed images of the corneal layers up to the cellular levels. Furthermore, it measured corneal thickness and permitted a precise positioning of each single recorded corneal lesion. All pictures were compared with those obtained in cornea free from any kind of inflammation and pathology. The images were classified according to their location within the cornea. The confocal analysis precisely located the lesions in corneal depth. The confocal images of corneal lesions of the child were compared to those of typical interstitial keratitis to support the diagnosis of classical CS. Results: In 3 adult patients with a certain diagnosis of classical Cogan Syndrome the lesions appear at least at 70 µm beneath the epithelium, they involve the whole stroma just up to the Descemet membrane. In the adult patient with the youngest corneal lesions, there was a portion of intact stroma 100 µm above the endothelium. The analysis of each single corneal lesion of the child revealed that they were located at different deepness: some resembling almost exactly those of the adults, others located more profoundly in the stroma. Conclusion: The confocal microscopy may be a valid support in the diagnosis of controversial cases of CS . Furthemore it may be helpful in surgical decision to precise the exact depth of the corneal lesion .
Keywords: keratitis • microscopy: confocal/tunneling • cornea: clinical science