Abstract
This study was aimed at observing the morphological changes of the cornea with ocular in vivo confocal microscopy (IVCM) in patients with Terrien's marginal degeneration (TMD). Ten patients (20 eyes) with TMD treated in the Department of Ophthalmology, Xiangya Hospital, and 10 healthy controls (20 eyes) were included in the current study. A detailed slit lamp microscopy, anterior segment photography, and corneal IVCM examination were performed for each eye. The density of central and marginal corneal epithelial cells, stromal cells, and subepithelial nerve fibers was compared between the two groups using the Wilcoxon rank sum test. Compared with the control group, the corneal epithelial and endothelial cells in the TMD group showed granular highly reflective substances and thinner subepithelial nerve fibers. The uneven dot-like highly reflective substances without cell structures appeared in the stromal layer of the cornea. The density of central and marginal corneal epithelial cells, stromal cells, and subepithelial nerve fibers was lower in the TMD group (p < 0.05), and they were negatively correlated with severity of the disease (p < 0.05). Our study demonstrated that the density of corneal epithelial cells, stromal cells, and sensory plexus nerve fibers was significantly reduced in the TMD group. The pathological changes were more obvious in the marginal cornea, and it is correlated with severity of the disease.
Highlights
Terrien’s marginal degeneration (TMD) is a chronic and bilateral marginal keratopathy [1], mainly characterized by sulcus thinning of corneal margins, corneal stromal atrophy, and lipid deposition, often accompanied by corneal neovascularization
Some studies have found that TMD had Journal of Ophthalmology hyperreflective substances deposition in the corneal epithelium, abnormal aberration of nerve fibers, activation of stromal cells, no cellular structural substances, and deposition of lipid layer particles by in vivo confocal microscopy (IVCM) [3, 4]
We investigated the corneal characteristic pathological changes of TMD on the in vivo level of cells by IVCM, which provides a clinical basis for clarifying the pathogenesis of TMD and provides a sensitive and specific detection method for the clinical diagnosis and follow-up of TMD patients
Summary
Terrien’s marginal degeneration (TMD) is a chronic and bilateral marginal keratopathy [1], mainly characterized by sulcus thinning of corneal margins, corneal stromal atrophy, and lipid deposition, often accompanied by corneal neovascularization. It progresses to corneal staphyloma and eventually corneal perforation in its advanced period. Some studies have found that TMD had Journal of Ophthalmology hyperreflective substances deposition in the corneal epithelium, abnormal aberration of nerve fibers, activation of stromal cells, no cellular structural substances, and deposition of lipid layer particles by IVCM [3, 4]. No previous studies have reported the correlation of IVCM findings and the severity of TMD or compared the pathological changes between the central and marginal cornea
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