PURPOSE: To test the hypothesis that anatomical and immunological changes are present in the cornea of patients affected by pterygium. MATERIALS AND METHODS: The central cornea of 20 eyes of 18 patients with primary pterygium was examined by in vivo confocal microscopy using a 40x lens and an axial resolution of 5 microm. The size of pterygia was measured by analyzing photographic images. Data from 20 age-matched normal subjects were used as control for analysis. RESULTS: The images obtained showed a significant lower number of epithelial cells in patients with pterygium compared to controls, with superficial epithelial cell area considerably higher than normal, reduced nucleus/cytoplasm ratio, halos around the nuclei, and sharp borders. Numerous highly reflective dendritic-like cells were present in the epithelial cell basal layer. The stroma showed a loss of keratocytes and the presence of lacunae. Tortuosity and number of vesicles of sub-basal nerves were significantly higher than controls. The endothelial cell count showed a normal density of cells of this layer. CONCLUSIONS: In vivo confocal microscopy may be helpful in evaluating the immunological and structural changes of the cornea in patients with pterygium and understanding its pathophysiology and the possible role of anti-inflammatory therapy.
PURPOSE: To test the hypothesis that anatomical and immunological changes are present in the cornea of patients affected by pterygium. MATERIALS AND METHODS: The central cornea of 20 eyes of 18 patients with primary pterygium was examined by in vivo confocal microscopy using a 40x lens and an axial resolution of 5 microm. The size of pterygia was measured by analyzing photographic images. Data from 20 age-matched normal subjects were used as control for analysis. RESULTS: The images obtained showed a significant lower number of epithelial cells in patients with pterygium compared to controls, with superficial epithelial cell area considerably higher than normal, reduced nucleus/cytoplasm ratio, halos around the nuclei, and sharp borders. Numerous highly reflective dendritic-like cells were present in the epithelial cell basal layer. The stroma showed a loss of keratocytes and the presence of lacunae. Tortuosity and number of vesicles of sub-basal nerves were significantly higher than controls. The endothelial cell count showed a normal density of cells of this layer. CONCLUSIONS: In vivo confocal microscopy may be helpful in evaluating the immunological and structural changes of the cornea in patients with pterygium and understanding its pathophysiology and the possible role of anti-inflammatory therapy.