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In Vivo Confocal Microscopy in the Diagnosis and Management of Dry Eye: A Focus on Imaging Protocols and Interpretation
Published on: November 11, 2025
Evaluation of intrastromal lipid deposits after intacs implantation using in vivo confocal microscopy
Linda T Ly1, James P McCulley, Steven M Verity
1University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX 75390-9057, USA.
Purpose:
To assess the structure and location of intrastromal lipid deposits after implantation of Intacs by using in vivo confocal microscopy.
Methods:
Seven eyes of six patients were examined by in vivo confocal microscopy 5 years (n = 6) or 2 months (n = 1) after uncomplicated implantation of Intacs for the correction of mild myopia. Selected images from all corneal layers were qualitatively evaluated for structural changes, with special attention paid to areas surrounding the Intacs implants.
Results:
In the peripheral cornea of eyes examined 5 years after surgery, epithelial and endothelial cell layers appeared normal. Tandem scanning confocal microscopy showed stromal haze surrounding the implants in all eyes examined, but no keratocyte activation was seen. Reflective amorphous or crystalline structures consistent with lipid deposition were detected in all eyes with long-term implantation of Intacs. Deposits were localized to the inner and outer edges of Intacs segments and to the region anterior to the implant. Confocal microscopy did not show any deposits in the eye examined 2 months after surgery, although the region anterior to the implant appeared hazy and edematous. Areas central to the implant appeared normal in all eyes.
Conclusions:
The mechanical and physiologic stresses introduced by the implantation of Intacs lead to the accumulation of lipid deposits in the extracellular matrix. By using in vivo confocal microscopy, the location and structure of these deposits can be determined.
