Anatomical and immunological changes of the cornea in patients with pterygium.

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.