IVCM was performed on all patients with a new generation confocal microscope, Heidelberg Retina Tomograph II-Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany).
Three randomized, nonoverlapping, high-quality digital images of the nasal, middle, and temporal lower eyelid (total of 9 images/eyelid) were used for calculation of the IVCM parameters.
We applied IVCM to further detect any changes in the ocular surface, especially the MG, on a cellular level.
In this study, we applied IVCM to those patients, who were assessed with similar dry eye severity by the current routine clinical examination while some patients complained of more suffering than others and revealed that the severer symptom patients indeed had worse alteration of MG morphology as well as increased inflammation cells and Langerhans cells, demonstrating that using IVCM as a supplementary diagnostic tool is critical for patients, in that regular assessment cannot explain their symptoms.
In this study, using IVCM, we found that there was severe degree of fibrosis and atrophy of MG in the severe symptom group patients, while the mild symptom group patients only showed marginal alteration of MG [Figure 1].