Confocal microscopy in the iridocorneal endothelial syndrome

Aims-To report the appearances of iridocorneal endothelial (ICE) syndrome f rom real time, white light confocal microscopy. Methods-Three consecutive patients, each with ICE syndrome, were examined p rospectively. Corneal specular and confocal microscopic examinations were p erformed in all three patients. In the first patient, a penetrating keratop lasty was performed and the cornea was examined by light and scanning elect ron microscopy. No surgery was performed in the remaining two patients. Results-In the first patient corneal oedema prevented endothelial specular microscopy. Confocal microscopy performed before penetrating keratoplasty s uccessfully revealed abnormal epithelial-like endothelial cells. Histologic al examinations of the cornea following penetrating keratoplasty revealed t he presence of multilayered endothelial cells with epithelial features (mic rovilli). In the remaining two patients, specular microscopy showed the pre sence of ICE cells with typical dark/light reversal. Confocal microscopy de monstrated groups of endothelial cells with epitheloid appearances. In all three patients, the contralateral endothelial appearance was normal by spec ular and confocal microscopy, except for moderate endothelial polymegathism in one patient. Epithelial-like endothelial cells were characterised by pr ominent nuclei on confocal microscopy. Conclusions-The application of confocal microscopy indicates that the ICE s yndrome is characterised by epitheloid changes in the endothelium. Confocal microscopy may be used to diagnose the ICE syndrome by demonstrating epith elial-like endothelial cells with hyperreflective nuclei. This technique is especially of value in cases of corneal oedema, since specular microscopy may fail to image the endothelium in such cases.