Sains Malaysiana 49(4)(2020): 817-824

http://dx.doi.org/10.17576/jsm-2020-4904-11

In vivo Slit Scanning Confocal Microscopic Observation in a Patient with Keratoconus Wearing Miniscleral Contact Lens for One Year: A Case Report

(Pemerhatian Pengimbas Celah Konfokus Mikroskop secara in vivo pada Pesakit dengan Keratokonus menggunakan Kanta Lekap Sklera Mini untuk Satu Tahun: Suatu Laporan Kes)

SOMNATH GHOSH¹, HALIZA ABDUL MUTALIB^2*, SHARANJEET KAUR² & RITUPARNA GHOSHAL²

¹Department of Allied Health Sciences, Brainware University, Barasat, Kolkata -700125, West Bengal, India

²Optometry and Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia

Received: 25 October 2018/Accepted: 6 December 2019

Abstract

The purpose of the present case report was to evaluate corneal microstructure in a patient with keratoconus wearing miniscleral contact lens (MS CL) for 1 year. A 38 years old patient diagnosed with stage III keratoconus in right eye and corneal graft (penetrating keratoplasty) in left eye was referred to optometry department of a public hospital in Malaysia. Based on the MS CLs fitting performance on the patient’s eye, MS CLs were prescribed in both eyes. However, patient opted for MS CL only in the right eye. In vivo slit scanning confocal microscopy was performed at baseline and after 1 year of contact lens wear in right eye. Qualitative analysis was done using a grading scale designed by Hollingsworth et al. (2005a), while quantitative analysis was performed using NAVIS software in a fixed frame of 0.06 mm². After 1 year of MS CL wear, qualitative observation of right cornea showed no change in stromal haze and architecture of nerve fibers. However, morphological alterations like dark bands were observed both in anterior and posterior stroma along with tendency of clustering keratocyte nuclei in posterior stroma. Quantitative analysis showed that anterior and posterior stroma keratocyte density and endothelium cell density were relatively low after 1 year of MS CL wear (817.3, 667.2, and 2577 cells/mm², respectively) caompared to baseline observation (850.7, 705.0, and 2666 cells/mm², respectively). Mean cell area of anterior stroma, posterior stroma and endothelium were also different in post MS CL wear. Polymegathism and pleomorphism calculated by NAVIS software were varied after 1 year (49.6% and 37.5%, respectively) compared to baseline (67.1% and 29.6%, respectively). In the discussed case, noticeable changes were observed in corneal microstructure after 1 year of MS CL wear. Thereby, in conclusion we recommend future studies with more number of keratoconic eyes wearing MS CLs to emphasize the findings on microstructural changes in keratoconic cornea wearing MS CLs.

Keywords: Confocal microscope; corneal microstructure; keratoconus; miniscleral lens

Abstrak

Laporan kes ini adalah bertujuan untuk mengkaji struktur mikro kornea pesakit keratokonus yang memakai kanta lekap sklera mini (MS CL) selama 1 tahun. Seorang pesakit berumur 38 tahun telah didiagnos dengan keratokonus tahap III pada mata kanan dan graf kornea (penetrating keratoplasty) pada mata kiri telah dirujuk ke Jabatan Optometri di hospital awam di Malaysia. Berdasarkan prestasi MS CL di atas mata pesakit beliau telah dipakaikan dengan MS CL pada kedua dua matanya. Walau bagaimanapun, pesakit memilih untuk memakai MS CL hanya pada mata kanan sahaja. Pengimbas celah konfokus mikroskop in vivo telah dijalankan pada garis dasar dan selepas setahun memakai kanta lekap pada mata kanan. Analisis kualitatif telah dilakukan dengan menggunakan skala penggredan rekaan Hollingsworth et al. (2005a), sementara analisis kuantitatif dilakukan dengan menggunakan perisian NAVIS yang menggunakan bingkai tetap 0.06 mm². Selepas 1 tahun memakai MS CL, kornea kanan secara kualitatif menunjukkan tiada perubahan pada kekabutan stroma, lapisan Bowman dan rangkaian corak saraf. Walau bagaimanapun, perubahan morfologi seperti jalur gelap telah kelihatan di anterior dan posterior stroma bersama dengan pengumpalan nukleus keratosit di posterior stroma. Analisis kuantitatif menunjukkan keamatan keratosit di stroma anterior dan posterior dan sel endotelium adalah rendah secara relatif selepas setahun pemakaian MS CL (817.3, 667.2 dan 2577 sel/mm²) berbanding dengan nilai garis dasar (850.7, 705.0 dan 2666 sel/mm²). Luas sel purata stroma anterior, stroma posterior dan endotelium didapati berbeza selepas pemakaian MS CL. Polimegatisme dan pleomorfisme dihitung menggunakan perisian NAVIS selepas 1 tahun (49.6% dan 37.5%) menunjukkan penurunan berbanding dengan garis datar (67.1% dan 29.6%). Seperti yang dibincangkan, perubahan ketara didapati pada struktur mikro kornea selepas setahun pemakaian MS CL. Sebagai kesimpulannya kami mengesyorkan kajian lanjut dengan mengambil lebih banyak mata keratokonus untuk dipasang dengan MS CL dan ini boleh menguatkan hasil penemuan perubahan struktur mikro mata keratokonus.

Kata kunci: Kanta sklera mini; keratokonus; konfokus mikroskop; struktur mikro kornea

REFERENCES

Alio, J.L. & Shabeyek, M.H. 2006. Corneal higher order aberrations: A method to grade keratoconus. J. Refract. Surg. 22(6): 539-545.

Bitirgen, G., Ozkagnici, A., Bozkurt, B. & Malik, R.A. 2015. In vivo corneal confocal microscopic analysis in patients with keratoconus. Int. J. Ophthalmol. 8(3): 534-539.

Bitirgen, G., Ozkagnici, A., Malik, R.A. & Oltulu, R. 2013. Evaluation of contact lens-induced changes in keratoconic corneas using in vivo confocal microscopy. Invest. Ophthalmol. Vis. Sci. 54(8): 5385-5391.

Bureau, J., Fabre, E.J., Hecquet, C., Pouliquen, Y. & Lorans, G. 1993. Modification of prostaglandin E2 and collagen synthesis in keratoconus fibroblasts, associated with an increase of interleukin 1 alpha receptor number. CR Acad. Sci. III. 316(4): 425-430.

Edmonds, C.R., Wung, S.F., Husz, M.J. & Pemberton, B. 2004. Corneal endothelial cell count in keratoconus patients after contact lens wear. Eye Contact Lens 30(1): 54-58.

Efron, N. 2007. Contact lens-induced changes in the anterior eye as observed in vivo with the confocal microscope. Prog. Retin. Eye Res. 26(4): 398-436.

Efron, N. & Hollingsworth, J.G. 2008. New perspectives on keratoconus as revealed by corneal confocal microscopy. Clin. Exp. Optom. 91(1): 34-55.

Efron, N., Mutalib, H.A., Perez-Gomez, I. & Koh, H.H. 2002. Confocal microscopic observations of the human cornea following overnight contact lens wear. Clin. Exp. Optom. 85(3): 149-155.

Erie, J.C., Patel, S.V., McLaren, J.W., Nau, C.B., Hodge, D.O. & Bourne, W.M. 2002. Keratocyte density in keratoconus. A confocal microscopy study(a). Am. J. Ophthalmol. 134(5): 689-695.

Ghosh, S., Mutalib, H.A., Sharanjeet, K., Ghoshal, R. & Retnasabapathy, S. 2017a. Effects of contact lens wearing on keratoconus: A confocal microscopy observation. Int. J. Ophthalmol. 10(2): 228-234.

Ghosh, S., Mutalib, H.A., Kaur, S., Ghoshal, R. & Retnasabapathy, S. 2017b. Corneal cell morphology in keratoconus: A confocal microscopic observation. Malaysian Journal of Medical Sciences 24(2): 44-54. 

Hollingsworth, J.G. & Efron, N. 2005. Observations of banding patterns (Vogtstriae) in keratoconus: A confocal microscopy study. Cornea 24: 162-166.

Hollingsworth, J.G., Bonshek, R.E. & Efron, N. 2005a. Correlation of the appearance of the keratoconic cornea in vivo by confocal microscopy and light microscopy. Cornea 24: 397-405.

Hollingsworth, J.G., Efron, N. & Tullo, A.B. 2005b. In vivo corneal confocal microscopy in keratoconus. Ophthalmic. Physiol. Opt. 25: 254-260.

Hayes, S., Boote, C., Tuft, S.J., Quantock, A.J. & Meek, K.M. 2007. A study of corneal thickness, shape and collagen organisation in keratoconus using videokeratography and X-ray scattering techniques. Exp. Eye Res. 84(3): 423-434.

Jhanji, V., Sharma, N. & Vajpayee, R.B. 2011. Management of keratoconus: Current scenario. Br. J. Ophthalmol. 95(8): 1044-1050.

Kaldawy, R.M., Wagner, J., Ching, S. & Seigel, G.M. 2002. Evidence of apoptotic cell death in keratoconus. Cornea 21(2): 206-209.

Krumeich, J.H., Daniel, J. & Knülle, A. 1998. Live-epikeratophakia for keratoconus. J. Cataract. Refract. Surg. 24(4): 456-463.

Mountford, J. 2011. KATT Fitting Instructions. http://capcl.com.au/custom-rgp-designs/).

Rabinowitz, Y.S. 1998. Keratoconus. Surv. Ophthalmol. 42(4): 297-319.

Radaie-Moghadam, S., Hashemi, H., Jafarzadehpur, E., Yekta, A.A. & Khabazkhoob, M. 2016. Corneal biomechanical changes following toric soft contact lens wear. J. Ophthalmic. Vis. Res. 11(2): 131-135.

Romero-Jimenez, M., Santodomingo-Rubido, J. & Wolffsohn, J.S. 2010. Keratoconus: A review. Cont. Lens Anterior Eye 33(4): 157-166.

Sawaguchi, S., Fukuchi, T., Abe, H., Kaiya, T., Sugar, J. & Yue, B.Y. 1998. Three-dimensional scanning electron microscopic study of keratoconus corneas. Archives of Ophthalmology 116(1): 62-68.

Sihota, R., Sharma, N., Panda, A., Aggarwal, H.C. & Singh, R. 1998. Post-penetrating keratoplasty glaucoma: Risk factors, management and visual outcome. Aust. NZJ Ophthalmol. 26(4): 305-309.

Somodi, S., Hahnel, C., Slowik, C., Richter, A., Weiss, D.G. & Guthoff, R. 1996. Confocal in vivo microscopy and confocal laser-scanning fluorescence microscopy in keratoconus. Ger. J. Ophthalmol. 5(6): 518-525.

Ucakhan, O.O., Kanpolat, A., Ylmaz, N. & Ozkan, M. 2006. In vivo confocal microscopy findings in keratoconus. Eye Contact Lens 32(4): 183-191.

Weed, K.H., MacEwen, C.J., Cox, A. & McGhee, C.N. 2007. Quantitative analysis of corneal microstructure in keratoconus utilising in vivo confocal microscopy. Eye (Lond). 21(5): 614-623.

Wilson, S.E., He, Y.G., Weng, J., Li, Q., McDowall, A.W., Vital, M. & Chwang, E.L. 1996. Epithelial injury induces keratocyte apoptosis: Hypothesized role for the interleukin-1 system in the modulation of corneal tissue organization and wound healing. Exp. Eye Res. 62(4): 325-327.

Yeniad, B., Yilmaz, S. & Bilgin, L.K. 2010. Evaluation of the microstructure of cornea by in vivo confocal microscopy in contact lens wearing and non-contact lens wearing keratoconus patients. Cont. Lens Anterior Eye 33(4): 167-170.

*Corresponding author; email: haliza@ukm.edu.my