REGISTRATION OF MORPHOLOGICAL-CHANGES IN THE HUMAN CORNEA AS A RESULTOF TREATMENT WITH CHLOROQUINE BY MEANS OF CONFOCAL IN-VIVO MICROSCOPY

Background: Chloroquine keratopathy is known as a disease with epithel ial deposits in the cornea. The appearance of corneal changes does not seem to be related to dose and du ration of treatment. Chloroquine ac cumulates in lysosomes. The purpose of this study was to investigate m icroscopic changes of corneal morphology in patients treated with chlo roquine in vivo. Patients and methods: Using the confocal slit scannin g microscope, we examined 16 patients during chloroquine treatment and 4 patients after treatment. The patients' age was between 33 and 75 y ears. They were treated with chloroquine over a minimum period of 2 mo nths up to a maximum period of 10 years. Results: In 12 of 20 patients , corneal changes were visible. An atypical inverse reflectivity of ba sal cells in comparison to healthy Volunteers was found. There were al so deposits in the wing cell layer. We saw a higher density in the ant erior stroma before the appearance of epithelial opacities, as well as in cases of keratopathy on slit-lamp examination and also after the c essation of chloroquine treatment. In one patient with long-term thera py there were atypically shaped and branched nerves in the anterior st roma. Conclusions: Using confocal microscopy,it was in some cases poss ible to detect changes in the corneal morphology before these changes could be detected by slit-lamp examination. As a result of this study we found that chloroquine keratopathy is not limited to the epithelium but can affect the anterior stroma and possibly neural structures.