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Letters |

In Vivo Confocal Laser Scanning Microscopy of Corneal Nerves in Leprosy

Chen Zhao, MD, PhD; Shasha Lu, MD, PhD; Nadja Tajouri, MD; Andre Dosso, MD; Avinoam B. Safran, MD
Arch Ophthalmol. 2008;126(2):282-284. doi:10.1001/archophthalmol.2007.67.
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Leprosy has a high incidence of ocular complications, including corneal lesions, lagophthalmos, iridocyclitis, and cataract. Involvement of the trigeminal nerve is common and can result in corneal hypoesthesia. Changes in corneal nerves might be the initial ocular manifestation.1

We describe a patient in whom leprosy developed without any apparent ocular complications. In vivo confocal microscopy, however, revealed abnormal corneal nerves. Being a noninvasive imaging technique, confocal microscopy plays a valuable role in visualization of corneal nerves in that condition.

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Figure 1.

For comparison, these in vivo confocal microscopy images show the normal appearance of basal epithelial and stromal nerves. A, Basal epithelial nerve plexus showing a preferred direction from 6 to 12 o’clock. B, Stromal nerve bundle appearing straight without beading and communicating branches.

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Figure 2.

Corneal epithelium in vivo confocal microscopy image of the right (A) and left (B) eyes showing thickened basal epithelial nerve bundles with local enlargements (arrows). C, The epithelial nerve plexus at the corneal apex demonstrating irregular orientations. D, Dendritic particles (arrows), sometimes interspersed between nerve bundles.

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Figure 3.

In vivo confocal microscopy images. A, Stromal nerves in the central cornea. In vivo confocal microscopy shows numerous stromal nerve bundles appearing tortuous, thin, and beaded, with some abnormal communicating branches. B, Peripheral stromal nerves were thickened, tortuous, and less numerous than central stromal nerves.

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