PURPOSE: To investigate the change of morphometric characteristics of the corneal cells by confocal microscopy in long-term soft contact lens wearer. METHODS: Confocal microscopy (ConfoScan 2.0, Fortune Technology, Italy) was used to obtain data from healthy volunteers and soft contact lens wearers for 10 years. We evaluated the morphological images of the corneal epithelium (superficial cell, wing cell), Bowman's membrane, stromal cells (anterior, middle, and posterior keratocyte), Descemet's membrane, and endothelium. RESULTS: In comparison with control, the wing cells from corneal epithelium of contact lens wearer appeared to have irregular and blurred cell borders, and enlarged subepithelial nerve plexus. The bowman's membrane and the anterior stroma showed an increased reflectivity. The keratocyte from a highly reflective area showed no definite cell border anteriorly and more distinct shape with less cellularity posteriorly. Descemet's membrane showed an evidence of vertical fold and keratocytes with long processes were arranged in parallel. The endothelial layer showed polymegathism and polymorphism with some gutta. CONCLUSIONS: According to these data, it would be suggested that a long-term wearing of soft contact lens could influence the morphology of corneal epithelium and stroma as well as of corneal endothelium.
Bowman Membrane ; Contact Lenses, Hydrophilic* ; Cornea* ; Corneal Stroma ; Descemet Membrane ; Endothelium ; Endothelium, Corneal ; Epithelium, Corneal ; Healthy Volunteers ; Microscopy, Confocal ; Stromal Cells

It is well known that the corneal stroma will swell when it is exposed to an aqueous solution or water in vitro, or when the limiting layers are removed in vivo. These in vivo experiments are concerned with the measurement and comparisons of corneal swelling after destruction of either of its layers (epithelium, endothelium and Descemet's membrane) and of reduction of corneal swelling with the application of epikeratoprosthesis (EKP). MATERIALS AND METHODS: Adult albino rabbits weighing 2-3kg each were used throughout these experiments. To remove the limiting layers, the rabbit was anesthesized with 0.5% pontocaine topical in epithelium removal group and nembutal systemically in another groups, and the epithelium was removed with gauze (Kim et ai, 1971) and the endothelium or/and Descemet's membrane was carefully removed with a specially bent hypodermic needle (Maurice and Giardini, 1951) under the aid of slit-lamp biomicroscope with high magnification. Suspicious cases were confirmed by inspection of sections of the excised cerneal tissues under the microscope after end day of experiments. The changes of corneal thickness were measured with the Mishima-Hedbys modified pachometer which was mounted on Haag Streit 900 slit-lamp. And EKP was made from the material of methylmethacrylate (Kaufman type), and its periphery was painted one mm broad with isobutyl cyanoacrylate as an adhesive. RESULTS AND SUMMERY: 1. The mean central corneal thickness of 48 normal rabbit eyes was 0.409mm +/- 0.005(S.E.) 2. The average rate of increase was initially about 0.4% of the thickness per minute for the epithelium, 0.7-0.9% per minute for the endothelium and endothelium plus Descemet's membrane, and 1.2% per minute for the whole layers. 3. After the removal of the epithelium the cornea swelled on the average to one half its thickness until after about 48 hrs and then returned its normal thickness with epithelium regrowth. 4. A significant difference was not found between the endothelium removal and the endothelium plus Descemet's membrane removal groups, and the maximal swelling of these was a little more of double of its original thickness. 5. After the removal of the epithelium, the endothelium and Descemet's membrane the corneal stroma swelled over 3 times of its original thickness after 24 hrs. 6. With the application of EKP on the bared stroma, its swelling could be limited under a double of its original thickness, and EKP treatment produced corneal thickness reductions of approximately 50% in early to about 100% in late in comparing with the whole layers removal group.
Adhesives ; Adult ; Bucrylate ; Cornea ; Corneal Stroma ; Descemet Membrane ; Endothelium ; Epithelium ; Humans ; Methylmethacrylate ; Needles ; Paint ; Pentobarbital ; Rabbits ; Tetracaine

Keratoconus (conical cornea) is a condition, beginning about puberty and developing mainly in females, in which the apex of the cornea thins gradually and usually bilaterally. The etiology is unknown. The presenting symptom is a reduction of the patient's vision owing to the development of a high degree of irregular myopic astigmatism. Early in the course of the disease the cornea does not look conical. The diagnosis of Keratoconus is confirmed by the distorted reflex observed with a Placido's disc and abnormal keratometer readings. In more advanced stages, signs include the obvious cone-shaped cornea and indentation of the lower lid by the cornea. By slit lamp biomicroscopy, vertical lines are noted in the deep layers of the stroma: the corneal nerve fibers are increasingly visible; and in about 50% of cases a yellow or green line is present around the base of the corn (Fleischer's ring). In advanced cases Bowman's membrane and Descemet's membrane rupture. Microscopically there is thinning of the tissue spaces between the corneal lamellae, fragmentation of the basement membrane of the comeal epithelium, fibrillation of Bowman's membrane, and folds or ruptures in Descemet's membrane. Acute hydrops may occur when Descemet's membrane ruptures. This is characterized by sudden cloudiness of vision due to imbibition of aqueous in the corneal stroma. However, as Descemet's membrane regenerates, the edema subsides. Permanent scarring may result if Bowman's membrane ruptures. Acute hydrops of the cornea was developed respectively in left eye on Oct, 1976 and in right eye on Dec, 1976 in a 13 year old Korean girl with Keratoconus O.U.
Adolescent ; Astigmatism ; Basement Membrane ; Bowman Membrane ; Cicatrix ; Cornea* ; Corneal Stroma ; Descemet Membrane ; Diagnosis ; Edema* ; Epithelium ; Female ; Humans ; Keratoconus* ; Nerve Fibers ; Puberty ; Reading ; Reflex ; Rupture ; Zea mays

PURPOSE: To report the confocal morphological changes of keratoconus in comparison with that of normal cornea. METHODS: Confocal microscopy (ConfoScan 2.0, Fortune Technology, Italy) was used to obtain data from healthy volunteers and keratoconus. We evaluated corneal morphological images of the corneal epithelium, Bowman's layer, stromal layer (anterior, middle, and posterior keratocyte), Descemet's membrane, and endothelium. RESULTS: In keratoconus cornea, the wing cells of epithelium had somewhat irregular margin, and the subepithelial nerve bundle was slightly enlarged. Near Bowman's membrane, highly reflective changes and tear like structure were visible. While the anterior stromal keratocyte had nuclei with a highly reflective density and indefinite cell border, posterior keratocyte had a more distinct shape with less cellularity. Near descemet's membrane, vertical fold (Vogt's striae) was observed and keratocytes with long processes arranged nearly in parallel. Morphological change was not observed in the endothelium. CONCLUSIONS: Our confocal microscopic findings of keratoconus may help early diagnosis and assessment of prognosis in the management of keratoconus.
Bowman Membrane ; Cornea ; Descemet Membrane ; Early Diagnosis ; Endothelium ; Epithelium ; Epithelium, Corneal ; Healthy Volunteers ; Keratoconus* ; Microscopy, Confocal ; Prognosis

PURPOSE: To analyze the morphology and density of corneal tissue in patients with early stage Fuchs' corneal endothelial dystrophy (FCED) by in vivo confocal microscopy (IVCM). CASE SUMMARY: Each layer of the cornea in 2 patients with early-stage FCED was examined with IVCM (ConfoScan 4.0, NIDEK, Co. Ltd., albignasego, Italy). Cross-sectioned corneal images of the corneal epithelium, Bowman's layer, stromal layer, Descemet's membrane, and endothelium were evaluated. Corneal epithelium, Bowman's layer, and anterior stroma of both patients showed no abnormalities. Case 1 was diagnosed as Stage 1 FCED, demonstrating typical changes including pleomorphism, polymegathism, and the presence of guttae in the corneal endothelial layer. Case 2 was diagnosed as Stage 2 FCED, showing several hyper-reflective whitish dots in the posterior stroma, hypo-reflective vertical strands in the stroma adjacent to Descemet's membrane, and pleomorphism, polymegathism, and guttae in the corneal endothelial layer. CONCLUSIONS: IVCM is a non-invasive and effective tool to diagnose early-stage FCED.
Cornea ; Descemet Membrane ; Endothelium ; Epithelium, Corneal ; Humans ; Microscopy, Confocal

In this immunohistochemical study we applied a monoclonal antibody(mAb) to evaluate the expression pattern of lymphocyte functionassociated antigen 3(LFA-3) in rabbit`s corneas before and after intracorneal injection of Candida albicans. Ten right eyes were induced to get immunocompromized cornea with subconjunctival injection of 2mg of dexamethasone once a day for 3 days(group I), and 10 left eyes had normal cornea without subconjunctival injection of dexamethazone(group II). Each 2 corneas in both group I and II were resected at 3, 12, 24 and 72 hours after intracorneal injection of C. albicans. Each 2 corneas without intracorneal injection of C. albicans in both groups were used as a control. The results were as follows: LFA-3 was expressed weakly on corneal epithlium in control of group I and group II. Expression of LFA-3 on vascular endothelium of group II was somewhat stronger than that of group I, LFA-3 was expressed moderately on vascular endothelium, and was detected on corneal stroma at 3 hors after intracorneal injection in both groups. Expression of LFA-3 on corneal stroma was slightly increased in both group II, and markedly increased in group I at 12 hours after intracorneal injection. Group II showed slightly increased LFA-3 expression on corneal and II to be expressed on corneal endothelium and inflammatory cells at 24 hours after injection. Its expression on corneal epithelium, stroma and endothelium was more increased in group II than in group I at that time. Group I showed moderate LFA-3 expression on corneal epithelium, corneal endothelium and inflammatory cells, and strong expression on corneal stroma and vascular endothelium at 72 hours after infection. Otherwise, LFA-3 expression in group II was weak to moderate n corneal epithelium, corneal endothelium and inflammatory cell, and moderate on corneal stroma and vascular endothelium. In this study, it was found that expression of LFA-3 in group I was weaker than that in group II in control and at 3 hours after intracorneal injection of C. albicans, but group I showed more strong LFA-3 expression than group II after 12 hours of intracorneal injection.
Antigens, CD58 ; Candida albicans* ; Candida* ; Cornea ; Corneal Stroma ; Dexamethasone ; Endothelium ; Endothelium, Corneal ; Endothelium, Vascular ; Epithelium, Corneal ; Lymphocytes ; Rabbits*

PURPOSE: We report a case of a horizontally penetrating injury of corneal stroma via an ejected irrigating needle during stromal hydration in cataract surgery. CASE SUMMARY: A 79-year-old woman presented with decreased visual acuity in her right eye. Her best corrected visual acuity in the right eye was 0.3. The cataract score of her right eye was nuclear opacity 3, cortical opacity 1−2, and posterior subcapsular opacity 1. She underwent phacoemulsification using a clear corneal approach while under topical anesthesia, and an intraocular lens was successfully implanted in the bag. A plastic syringe with an irrigating needle was used to hydrate the corneal stroma at the clear cornea site. As a result of the increased pressure applied to the connection between the syringe and irrigating needle, the loosened irrigating needle was forcefully ejected toward the corneal endothelium, horizontally penetrating the stroma without injuring the corneal epithelium. On the 1st postoperative day, her right eye exhibited a visual acuity of 0.5, astigmatism of −1.25 diopter (D) cyl., corneal edema with Descemet's folds, and insignificant scarring of the corneal endothelium. Three weeks after surgery, the visual acuity was 0.9, the astigmatism was −0.50 D, and any other abnormalities such as corneal opacity were no longer present. CONCLUSIONS: Despite a penetrating needle injury through the corneal endothelium and stroma, the corneal wound healing process did not result in corneal opacity or worsened astigmatism. To prevent sequela due to an ejected irrigating needle, operators and assistants should be actively aware of tight locking between the needle and syringe.
Aged ; Anesthesia ; Astigmatism ; Cataract ; Cicatrix ; Cornea ; Corneal Edema ; Corneal Opacity ; Corneal Stroma ; Endothelium, Corneal ; Epithelium, Corneal ; Female ; Humans ; Lenses, Intraocular ; Needles* ; Phacoemulsification ; Plastics ; Syringes ; Visual Acuity ; Wound Healing

Dermoid is a kind of choristoma and rare congenital benign tumor. It is ugly in appearance and especially dermoid appears at corneal limbus. The above 2 cases which we report invade cornea and it is especially giant compared with the report which has been reported untill now.
Choristoma ; Cornea ; Dermoid Cyst* ; Limbus Corneae

PURPOSE: This study evaluated the effect and safety of photodynamic therapy (PDT) with verteporfin retreatment on patients with corneal neovascularization. METHODS: Corneal neovascularization was induced with a silk suture of the corneal stroma in 24 white rabbits (48 eyes). Four rabbits were examined histologically before performing PDT. Ten rabbits were chosen randomly, one eye from each rabbit was treated with PDT at 50 J/cm2, and the other eye was used as a control. Both eyes of the remaining 10 rabbits were treated with PDT at 150 J/cm2. One week later, one eye was further retreated with PDT at the same intensity. The area of corneal neovascularization was measured and evaluated histologically using light and electron microscopies. RESULTS: The least neovascularized area was observed in the retreated group (P=0.04). The histologic examination revealed fewer new corneal vessels in the retreated group, but the corneal epithelium, stroma, and endothelium showed a normal appearance. Results from electron microscopic examination demonstrated thrombi as well as destruction and nuclear fragmentation of the vascular endothelial cells. However, there were no other changes in the cornea except for vascular endothelial cells, even in the retreated group. CONCLUSIONS: In conclusion, these results suggest that PDT with verteporfin retreatment appears to be safe and significantly more effective in patients with regression of corneal neovascularization.
Cornea ; Corneal Neovascularization ; Corneal Stroma ; Electrons ; Endothelial Cells ; Endothelium ; Epithelium, Corneal ; Eye ; Humans ; Light ; Microscopy ; Photochemotherapy ; Porphyrins ; Rabbits ; Retreatment ; Silk ; Sutures ; Triazenes

PURPOSE: To compare preoperative and postoperative thickness and to investigate the difference in the thickness change of corneal epithelium and stroma after cataract surgery through scleral tunnel incision. METHODS: Forty eyes of forty patients who were 40 years old or older and underwent small-incision superior scleral tunnel cataract surgery with phacoemulsification were included. Using the RTVue instrument (Optovue Inc., Fremont, CA, USA), corneal epithelial (ET) and stromal thicknesses (ST) of all subjects were measured preoperatively and at 3 days, 1 week, and 1 month postoperatively. Thicknesses were classified into 3 zones according to the distance from the vertex: central zone (within 2 mm), paracentral zone (2-5 mm diameter) and midperipheral zone (5-6 mm diameter). RESULTS: Mean central ST was 486.68 ± 25.15 µm, 535.16 ± 48.13 µm, 515.98 ± 44.07 µm, and 502.28 ± 34.87 µm preoperatively, and at 3 days, 1 week, and 1 month postoperatively, respectively (p < 0.001 for all). ST showed significant thickening in all three zones from 3 days to 1 month postoperatively (p < 0.001 for all). Mean central, paracentral, and midperipheral ET was 52.13 ± 3.41 µm, 50.42 ± 2.97 µm, 49.12 ± 3.05 µm at preoperatively and 51.03 ± 3.63 µm, 48.96 ± 3.62 µm, 47.67 ± 3.81 µm at 1 month postoperatively, respectively (p = 0.061, 0.006, 0.001, respectively), while there were no signficant changes in all three zones at 3 and 7 days postoperatively. Changes in ET and ST were prominent at the superotemporal incision site. CONCLUSIONS: After scleral tunnel cataract surgery, corneal edema was observed in the stroma immediately after surgery. There was no significant change at early times after surgery in the epithelium, and there was a decrease in the peripheral cornea at 1 month postoperatively. The change in ET was considered a compensatory change due to stromal edema and appeared between 1 week to 1 month postoperatively.
Cataract* ; Cornea ; Corneal Edema ; Corneal Stroma ; Edema ; Epithelium ; Epithelium, Corneal ; Humans ; Phacoemulsification