Posters

Clinical applications of in vivo confocal microscopy in Meesmann corneal dystrophy: confirming diagnosis through an “open-mosaic” eye view

Poster Details

First Author: C.Gines Gallego SPAIN

Co Author(s): F. Huelin   D. Díaz-Valle                 

Abstract Details

Purpose:

To describe the microstructural findings provided by confocal laser scanning microscopy (CLSM) and report its diagnostic applications in a 45-year-old man with a long-lasting history of decreased visual acuity in both eyes and clinical features suggestive of Meesmann corneal dystrophy (MCD).

Setting:

Clinical assessment, confocal scan and other complementary tests, and further follow-up of the patient were carried out in the Department of Cornea and Ocular Surface at Hospital Universitario Clínico San Carlos, in Madrid, Spain.

Methods:

Since first consultation at our centre, the patient underwent periodical slitlamp examinations which revealed clinical findings suggestive of an anterior corneal dystrophy. For further diagnostic approach, in vivo CLSM was performed and images from all corneal layers were captured using the automatic full thickness and epithelial modes, with special attention to the anterior parts; the manual analytic software was utilized afterwards to measure the abnormal findings. An anterior segment optical coherence tomography (AS-OCT) was also performed during clinical follow-up and diagnostic process.

Results:

Best-spectacle corrected visual acuity (BSCVA) on arrival was 0.5. Slitlamp biomicroscopy revealed diffuse bilateral microcystic intraepithelial lesions appearing as punctate, bubble-like, round-to-oval opacities, together with mild corneal haze and intense keratitis. An in vivo CLSM showed well delineated cystic lesions containing hyperreflective points, and hyporreflective areas in the basal epitelial layer. AS-OCT evidenced some intraepithelial cysts, but resolution was not high enough for a detailed picture. These features in the context of the patient’s history were consistent with the diagnosis of MCD. The patient continues follow-up at our centre, with current BSCVA 0.3 and no symptoms under lubricating treatment.

Conclusions:

MCD is a rare bilateral corneal epithelial disorder whose ethiopatogenesis has been related to mutations in the keratin genes KRT3 and KRT12, following an autosomal dominant inheritance pattern. Diagnosis is based on clinical findings on slitlamp biomicroscopy, and may be further confirmed histopathologically, or microstructurally through CLSM. Since surgery is not indicated in the majority of patients, histopathologic exam may be difficult to obtain; to this respect, CLSM allows a rapid evaluation of all corneal layers and can therefore provide a non-invasive method for confirming the diagnosis of this infrequent but potentially disabling corneal disorder.

Financial Disclosure:

None