Confocal microscopy used as the definitive diagnostic method in atypical iridocorneal endothelial syndrome

Objective To discuss the diagnostic potential of confocal microscopy for iridocomeal endothelial(ICE)syndrome.Methods Eight patients(six patients unilaterally involved and two patients bilaterally involved)of suspected ICE syndrome,which can't be diagnosed with conventional examination,were collected.Tbe corneal endothelium of all eight patients were detailedly investigated by confocal microscopy.Results In-vivo confocal microscopy highlighted larger and irregularly shaped endothelial cells with marked hyperrefleetive nuclei in all eight patients and indistinct cellular borders in seven patients.Cells with two or more nuclei, nuclei with sublobes or adjacent to the cellular borders could be found.Several patients exhibited local loss of endothelial cells, ring-shaped dark area in the cells, cells appearing during the division phase, and so on. The contralateral eyes in 3 patients with unilateral ICE syndrome exhibited lower endothelial cell density and less homogenicity in cellular size.According to confocal microscopy,the eight patients were diagnosed as two cases of progressive essential iris atrophy, four cases ofChandler's syndrome and two cases ofCogan Reese syndrome.Conclusion Confocal microscopy,which allows the hurtless evaluation ofthe corneal endothelium at the cellular level,can be used as the definitive,early diagnostic method in ICE syndrome,despite the presence of corneal edema.The technique has great potential for diagnosing ICE syndrome, especially for the atypical cases. Key words: Iridocorneal endothelial syndrome; Confocal microscopy; Corneal endothelium