Clinical use of in vivo confocal microscopy through focusing in corneal refractive surgery

To illustrate the use of in vivo confocal microscopy through focusing to observe normal cornea and corneal wound healing after excimer laser refractive surgery.

A total of 197 eyes, including both unoperated eyes and eyes that had undergone LASIK, photorefractive keratectomy (PRK), or laser epithelial keratomileusis (LASEK), were examined using in vivo confocal microscopy through focusing. Images of the various corneal layers resolved by confocal microscopy through focusing were recorded and analyzed. Pachymetry of the cornea, epithelium, and stroma was also recorded for all eyes. The t test was used to evaluate the differences between unoperated eyes and postoperative eyes and the change in corneal pachymetry preoperatively to postoperatively with each type of surgery. A P value <.05 was considered statistically significant.

Each layer of the cornea could be resolved in unoperated eyes and eyes that had undergone refractive surgery. Wound healing could be followed over time using confocal microscopy through focusing. In eyes that underwent PRK, at 1 month postoperatively, the entire cornea and stroma were thinner than preoperatively, whereas the epithelial layer was statistically significantly thicker (P<.05). Haze after PRK is seen as reflectivity of subepithelial anterior stroma. No clinically significant haze was observed in eyes that underwent LASEK or LASIK. The features of the eyes that underwent LASIK were the same as those of unoperated eyes.

Confocal microscopy through focusing was useful in documenting cellular morphology in unoperated corneas and corneas that had undergone refractive surgery. Wound-healing characteristics of eyes that had undergone refractive surgery were also documented using confocal microscopy.