PURPOSE: To report the in vivo confocal microscopy (CM) findings of a patient with combined pre-Descemet membrane corneal dystrophy and Fuchs endothelial dystrophy. METHODS: A 38-year-old woman with pre-Descemet membrane corneal dystrophy and Fuchs endothelial dystrophy was studied. Routine ophthalmic examination, standard slit-lamp biomicroscopy, pachymetry, and in vivo CM analysis of the morphology of the corneal epithelium, subbasal nerves, stroma, and endothelium were performed. RESULTS: Biomicroscopy revealed bilateral corneal guttae with central corneal edema, beaten metal appearance, and pigment dusting of the endothelium. Numerous tiny pleomorphic opacities located in the deep stroma immediately anterior to Descemet membrane were evidenced in both eyes. In vivo CM showed numerous pleomorphic and highly reflective small particles in the cytoplasm of keratocytes in the deep stroma adjacent to the corneal endothelial layer. No abnormalities could be detected in the epithelial layer and in the midstromal layer. In the endothelial layer, there were multifocal hyporeflective areas with occasional central highlight among hyperreflective endothelial cells. The ultrasonic pachymetry showed corneal thicknesses of 652 and 628 μm in the right eye and in the left eye, respectively. CONCLUSIONS: In vivo CM is a powerful tool in the study of rare corneal dystrophies and degenerations and nonprogressive or slowly progressive corneal disorders where there is a limited availability of corneal tissue for examination and when the final diagnosis is difficult to obtain with conventional methods.
PURPOSE: To report the in vivo confocal microscopy (CM) findings of a patient with combined pre-Descemet membrane corneal dystrophy and Fuchs endothelial dystrophy. METHODS: A 38-year-old woman with pre-Descemet membrane corneal dystrophy and Fuchs endothelial dystrophy was studied. Routine ophthalmic examination, standard slit-lamp biomicroscopy, pachymetry, and in vivo CM analysis of the morphology of the corneal epithelium, subbasal nerves, stroma, and endothelium were performed. RESULTS: Biomicroscopy revealed bilateral corneal guttae with central corneal edema, beaten metal appearance, and pigment dusting of the endothelium. Numerous tiny pleomorphic opacities located in the deep stroma immediately anterior to Descemet membrane were evidenced in both eyes. In vivo CM showed numerous pleomorphic and highly reflective small particles in the cytoplasm of keratocytes in the deep stroma adjacent to the corneal endothelial layer. No abnormalities could be detected in the epithelial layer and in the midstromal layer. In the endothelial layer, there were multifocal hyporeflective areas with occasional central highlight among hyperreflective endothelial cells. The ultrasonic pachymetry showed corneal thicknesses of 652 and 628 μm in the right eye and in the left eye, respectively. CONCLUSIONS: In vivo CM is a powerful tool in the study of rare corneal dystrophies and degenerations and nonprogressive or slowly progressive corneal disorders where there is a limited availability of corneal tissue for examination and when the final diagnosis is difficult to obtain with conventional methods.