Observation of dendritic cells in corneal graft disease in keratoconus patient after deep anterior lamellar keratoplasty using confocal microscopy imaging

Abstract

AbstractPurpose The aim of this study was to present the applicability of corneal confocal microscopy for the early identification and monitoring of treatment efficacy in corneal graft disease.Methods In the 45‐year‐old patient after transplantation because of keratoconus, suspected of graft rejection was performed the following tests: basic slit lamp examination, corneal scans using a Scheimpflug camera (Pentacam, OCULUS) and corneal confocal microscopy in vivo (Rostock Cornea Module Heidelberg Retina Tomograph III Engineering). The study was performed on admission and one week and two weeks after the implementation of local steroids.Results In a slit lamp examination, uncharacteristic macroscopic changes were described ‐ focal turbidity, endothelial deposits and oedema. In an examination with the Scheimpflug camera, endothelial deposits were seen as highly hiperreflective structures reaching the level of the endothelium to the posterior of the corneal stroma. These symptoms are not also unique to transplant disease. In order to search for microstructural evidence of rejection underwent corneal confocal microscopy in which visualized monomorphic intense infiltration of inflammatory cells and dendritic cells, located primarily in the area near the posterior stroma and Descemet membrane. During the steroidotherapy reduction with number of dendritc cells were observed cell infiltration set up to complete disappearance of their normal structure and appearance of the endothelium.Conclusion Corneal confocal microscopy is a useful method for early detection and monitoring of disease corneal transplant.