Observation of dendritic cells in subclinical corneal graft disease using confocal microscopy imaging

Abstract

AbstractPurpose The aim of this study was to show the applicability of confocal microscopy for the diagnosis of corneal graft disease in presence of masking corneal changes.Methods The examined group consisted of 12 patients with suspected corneal graft rejection, in which the local state of the cornea caused difficulties in diagnosis. 7 patients was after DALK procedure, 4 after PK, 1 after DSAEK. Local state of corneal transplant included: edema in secondary glaucoma (3 patients), inflammation with ulceration (3 patients), edema in bullous keratopathy (1 patient), edema in keratouveitis (4 patients), haze after inflammation (1 patient). We performed following procedures: slit lamp examination, scans using a Scheimpflug camera (Pentacam, OCULUS), confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III).Results In a slit lamp examination, uncharacteristic macroscopic changes were described ‐ focal turbidity, endothelial deposits and edema. In an examination with the Scheimpflug camera an increased thickness and haze in the posterior stroma was reported. In order to search for microstructural evidence of rejection underwent corneal confocal microscopy which in 11/12 cases showed infiltration of dendritic cells. These cells were located at well‐defined depth (where the adhesion of the corneal transplant) and was not appearing in other parts of the cornea.Conclusion In vivo confocal microscopy is a useful method for the detection of corneal transplant disease also in presence of local changes masking rejection symptoms. This examination is characterized by high sensitivity and ranges in this study of about 92%.