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. 1999 Jun;83(6):697–702. doi: 10.1136/bjo.83.6.697

Confocal microscopy in the iridocorneal endothelial syndrome

A Chiou 1, S Kaufman 1, R Beuerman 1, T Ohta 1, V Yaylali 1, H Kaufman 1
PMCID: PMC1723063  PMID: 10340979

Abstract

AIMS—To report the appearances of iridocorneal endothelial (ICE) syndrome from real time, white light confocal microscopy.
METHODS—Three consecutive patients, each with ICE syndrome, were examined prospectively. Corneal specular and confocal microscopic examinations were performed in all three patients. In the first patient, a penetrating keratoplasty was performed and the cornea was examined by light and scanning electron microscopy. No surgery was performed in the remaining two patients.
RESULTS—In the first patient corneal oedema prevented endothelial specular microscopy. Confocal microscopy performed before penetrating keratoplasty successfully revealed abnormal epithelial-like endothelial cells. Histological examinations of the cornea following penetrating keratoplasty revealed the presence of multilayered endothelial cells with epithelial features (microvilli). In the remaining two patients, specular microscopy showed the presence of ICE cells with typical dark/light reversal. Confocal microscopy demonstrated groups of endothelial cells with epitheloid appearances. In all three patients, the contralateral endothelial appearance was normal by specular and confocal microscopy, except for moderate endothelial polymegathism in one patient. Epithelial-like endothelial cells were characterised by prominent nuclei on confocal microscopy.
CONCLUSIONS—The application of confocal microscopy indicates that the ICE syndrome is characterised by epitheloid changes in the endothelium. Confocal microscopy may be used to diagnose the ICE syndrome by demonstrating epithelial-like endothelial cells with hyperreflective nuclei. This technique is especially of value in cases of corneal oedema, since specular microscopy may fail to image the endothelium in such cases.



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Figure 1  .

Figure 1  

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(A) Confocal microscopic appearance of normal endothelial cells from a normal subject. (B) Confocal microscopy (original magnification ×210 ). Abnormal endothelial cells with well identifiable nuclei resembling the confocal microscopic appearance of corneal epithelial cells were found. The cells were relatively regular in shape and size. The dark oval image at the upper part of the picture is an artefact.

Figure 2  .

Figure 2  

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Light microscopy. Histological examination of the endothelium demonstrated multilayered epithelial-like cells.

Figure 3  .

Figure 3  

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Scanning electron microscopy. Microvilli were found in abnormally high numbers on the surface of many endothelial cells (upper half of the photograph).

Figure 4  .

Figure 4  

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Specular microscopy. (A) Rounded dark cells with light borders and occasional light bodies within cell boundaries could be identified in the endothelium of the abnormal cornea. (B) In the fellow eye, the endothelium exhibited polymegathism, but no characteristics of ICE syndrome.

Figure 5  .

Figure 5  

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Confocal microscopy (original magnification ×210). (A) Epithelial-like endothelial cells with well recognisable nuclei, of which some are indicated by arrows, were detected. Note the regularity of the cells. (B) Less hyperreflective cell bodies with central hyperreflective nuclei resembling the confocal microscopic appearance of epithelial wing cells were seen. The cells were relatively regular in size and shape. (C) Areas of highly abnormal cells characterised by marked epithelial-like appearance and loss of regularity in size and shape were found. Hyperreflective structures were found within and adjacent to these abnormal areas. Relatively normal appearing endothelial cells were also detected (upper right corner of the photograph).

Figure 6  .

Figure 6  

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Specular microscopy. Endothelial cells are seen with dark/light reversal and occasional central bright reflex in the clinically abnormal eye (A), not in the normal eye (B).

Figure 7  .

Figure 7  

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Confocal microscopy (original magnification ×210). The arrows indicate some epithelial-like endothelial cells with nuclear hyperreflectivity.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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