[Cellular laser microscopy of corneal ulcer and infiltrate]

Corneal ulcers can be observed occasionally due to infections, wearing contact lenses or in dry eyes. Confocal microscopy represents a new tool for the differential diagnostic work-up of pathological processes and provides the possibility for dynamic healing control.

We report on the corneal morphological changes caused by corneal ulcers of varying aetiologies. Morphological changes and pathological processes in infiltrates as well as in ulcus corneae can be investigated by means of the confocal in vivo microscopy based on the confocal laser scanning microscope model Heidelberg Retina Tomograph II with the Rostock cornea module.

Corneal infiltrates are characterised by inflammatory cell infiltration without other morphological changes. An advanced process like corneal ulcer is characterised by not only the tissue defects but also by oedematous structures of the entire cornea resulting in an increase in corneal thickness, increased cell density of leukocytes and of Langerhans cells. The scar tissue formation as well as epithelium regeneration are documented during the follow-up. Confocal detection of pathogens (acanthamoeba, fungus, etc.) was performed.

The confocal microscopic data about micromorphological changes could be useful in the evaluation of defect geometry and healing processes of the cornea. Differential diagnostic distinction between bacterial, fungal or acanthamoeba genesis is possible.