Microstructural evidence of the anterior ocular surface alteration in patients with pterygium

Purpose: To study microstructural changes in cornea and conjunctiva of patients with pterygium using in vivo laser scanning confocal microscopy (LSCM).Methods: Seventy eyes of 64 patients with pterygium and 70 eyes of 70 healthy subjects were examined. Using LSCM in vivo images at microstructural level were captured. The density of keratocytes in the anterior and posterior stroma and basal corneal epithelial cells and the density of specific cellular structures of the pterygium were calculated. Comparative analysis of the central cornea and nasal bulbar conjunctiva of the control subjects was performed.Results: Density of basal corneal epithelial cells and anterior keratocytes in corneas with pterygium was determined at: 4678±41 cells/mm² and 424±17 cells/mm² respectively, which was lower than that in the controls. Dendritic cells with density 115±11 cells/mm² were found in regions of pterygia. The dendritic cell density in the pterygium was found higher than the density in the nasal bulbar conjunctiva of the healthy eyes. Morphologic alterations of the sub-basal nerve plexus were observed in pterygium, as well as bright deposits at the level of the basal epithelial layer and also hyperreflective spots in the surface epithelium, corresponding to the clinically observed Fuchs` flecks.Conclusions: In vivo LSCM is method of choice for dynamic evaluation of the morphologic alterations of pterygium, allowing precise diagnosis, prognosis and monitoring of this disease. Study highlighted microstructural alterations and increased dendritic cells presumed to be characteristic of pterygium and adjacent to it clear cornea