Enhancing Clinical Decision-Making in Complex Corneal Disorders: The Role of In-Vivo Confocal Microscopy

Alberto Recchioni, Ankur Barua, Alberto Dominguez-Vicent

Research output: Contribution to journalArticlepeer-review


This study aims to describe how in-vivo confocal microscopy (ICVM) results improved diagnosis and treatment in three patients with complex corneal disorders at a single institution. Case one was a 36-year-old woman contact lens wearer referred to the hospital eye service (HES) by her community optician for a suspected corneal ulcer in her left eye. The case demonstrated that where laboratory cell culture was inconclusive, IVCM imaging improved diagnosis and more importantly adjusted the initial treatment till the complete resolution of the case. Case two was a shared-care 66-year-old keratoconus patient under a complex immunosuppression regime who had developed a recent series of post-surgical complications of fungal origin and was experiencing eye pain. IVCM was able to differentiate between an immune-mediated response and fungal keratitis and guide the clinicians towards an optimized treatment. Case three was a long-standing dry eye disease in a 64-year-old woman diagnosed with primary Sjögren’s syndrome where previous treatments failed to improve her symptomatology. IVCM was crucial for prescribing allogeneic serum eyedrops by anticipating early immune changes in the sub-basal corneal nerve plexus. In-vivo confocal microscopy can be an essential non-invasive imaging technique for improving clinicians’ diagnostic precision by adding a layer of certainty that other techniques may lack. Additionally, IVCM allows adjustment of the treatment accordingly, by instantly following any pathologic changes at the cellular level.
Original languageEnglish
Article number679
Number of pages7
Issue number3
Early online date2 Mar 2023
Publication statusPublished - 2 Mar 2023

Bibliographical note

Copyright © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).


  • acanthamoeba keratitis
  • anterior eye
  • dry eye
  • fungal keratitis
  • in-vivo confocal microscopy
  • microbial keratitis
  • neuropathic pain


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