In Vivo Confocal Microscopy of Bleb-like Disorder in Epithelial Basement Membrane Dystrophy

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Purpose:To report the confocal microscopic appearance of bleb-like disorder in epithelial basement membrane dystrophy (EBMD).Methods:Two subjects with bleb-like disorder in EBMD were examined with slit-lamp biomicroscopy and in vivo confocal microscopy using the Heidelberg Retina Tomograph II/Rostock Cornea Module. A sample obtained from epithelial debridement from 1 subject provided histologic correlation.Results:Confocal microscopy showed areas of circular and irregular hyporeflectivity ranging from 30 to 150 μm in diameter at the level of the basal epithelium and Bowman layer, with apparent fragmentation of the subbasal nerve plexus. The stroma, Descemet membrane, and corneal endothelium appeared normal. The epithelial biopsy results revealed subepithelial deposits of material anterior to the Bowman layer that stained positively with periodic acid–Schiff (PAS).Conclusions:This clinicopathologic correlation of bleb-like disorder in EBMD using confocal microscopy demonstrates the distinctive morphology of this disorder. It provides additional information to help with the interpretation of confocal images.

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