IN-VIVO CONFOCAL MICROSCOPY ASSESSMENT OF CORNEAL CHANGES IN ENDOART PATIENTS: PRE- AND POST-SURGERY

To investigate structural changes in corneal layers and thickness in patients undergoing EndoArt implantation, using In-vivo confocal microscopy (IVCM) to assess alterations pre- and post-operatively. IVCM offers specific advantages for EndoArt patients, including high-resolution visualization of corneal layers, detailed endothelial cell monitoring and assessment of nerve regeneration through sub-basal nerve plexus imaging. It also allows for both quantitative (cell density, thickness) and qualitative (morphological) assessments, providing a comprehensive view of corneal changes post-surgery.

This report aims to provide insights into corneal healing dynamics, structural recovery, and short-term outcomes in corneal health following EndoArt interventions in patients with a history of DSAEK and glaucoma drainage device (GDD) surgery, who subsequently developed graft failure.

This case was managed and documented at the Ophthalmology Department at Hanusch Hospital Vienna, utilizing IVCM to monitor pre- and post-operative changes.

To assess changes in corneal layer structure and thickness in patients treated with EndoArt, three patients with a history of both DSAEK and GDD surgery were recruited. Anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM) were performed preoperatively and three months postoperatively.

Both AS-OCT and confocal microscopy provided complementary findings. AS-OCT detected a postoperative decrease in stromal thickness by the three-month follow-up, while IVCM scans showed a gradual reduction in corneal edema, allowing clearer visualization of cellular structures. The epithelial layer began to re-emerge, and keratocytes within the corneal stroma became distinguishable, corresponding with clinical improvements. Additionally, changes in sub-basal nerve density were observed, with gradual regeneration noted at the three-month follow-up.

The combination of AS-OCT and confocal microscopy provided a comprehensive evaluation of corneal layer dynamics following EndoArt implantation. The results highlight transient changes in stromal thickness and a gradual recovery of the endothelium and nerve layers post-implantation. These findings underscore the efficacy of IVCM as a valuable tool for assessing structural changes in the cornea following EndoArt treatment.