Confocal microscopy in cornea guttata and Fuchs' endothelial dystrophy

Aims-To report the appearances of cornea guttata and Fuchs' endothelial dys trophy from white light confocal microscopy. Methods-Seven eyes of four consecutive patients with cornea guttata were pr ospectively examined. Of the seven eyes, three also had corneal oedema (Fuc hs' dystrophy). In vivo white light tandem scanning confocal microscopy was performed in all eyes. Results were compared with non-contact specular microscopy. Results-Specula r microscopy was precluded by corneal oedema in one eye. In the remaining s ix eyes, it demonstrated typical changes including pleomorphism, polymegath ism, and the presence of guttae appearing as dark bodies, some with a centr al bright reflex. In all seven eyes, confocal microscopy revealed the prese nce of round hyporeflective images with an occasional central highlight at the level of the endothelium. Changes in cell morphology and size were read ily appreciated. Conclusion-By comparison with specular microscopy, the hyporeflective image s with an occasional central highlight seen on confocal microscopy are cons istent with the presence of guttae. Confocal microscopy may confirm the dia gnosis of cornea guttata and Fuchs' endothelial dystrophy by demonstrating the presence of guttae. This technique is especially valuable in cases of c orneal oedema, where specular microscopy may fail to visualise the endothel ium. However, specular microscopy should remain the method of choice to eva luate the endothelium, principally because it is easier to use.