Confocal in vivo microscopy and confocal laser scanning fluorescence microscopy of the human cornea in keratoconus and bullous keratopathy

The purpose of this study was to determine alterations of corneal cell morphology and organization in keratoconus and bullous keratopathy. Patients were examined in vivo using the confocal slit scanning microscope Microphthal(R). After penetrating keratoplasty recipient's trephanates were stained with the LIVE/DEAD(R)kit and examined using the confocal laser scanning fluorescence microscope Diaphot 300(R)/ODysseyXL(R). Fluorescence images were reconstructed three-dimensionally. Morphological changes were present in all cell layers. In keratoconus these alterations were only found in the apical region, whereas the whole cornea was affected in bullous keratopathy. The morphological alterations found may be characteristic for keratoconus and bullous keratopathy respectively. The 3-D reconstruction permits information about the spatial organization and changes of the keratocyte network.