Characteristics of Pre-Descemet Membrane Corneal Dystrophy by Three Different Imaging Modalities-In Vivo Confocal Microscopy, Anterior Segment Optical Coherence Tomography, and Scheimpflug Corneal Densitometry Analysis

Purpose:To evaluate the characteristics of pre-Descemet membrane corneal dystrophy by 3 different imaging modalities: in vivo confocal microscopy (IVCM), anterior segment optical coherence tomography (ASOCT), and Scheimpflug corneal densitometry analysis.Methods:A 32-year-old male patient with pre-Descemet membrane corneal dystrophy was subjected to imaging by IVCM, ASOCT, and Scheimpflug tomography.Results:Slit-lamp biomicroscopy showed the presence of tiny pleomorphic opacities in the posterior stroma, immediately anterior to Descemet membrane bilaterally. On IVCM, pleomorphic, hyperreflective punctate particles were seen both intracellularly and extracellularly in the anterior and mid stroma with increased reflectivity of some keratocytes that, however, were of normal size. These changes increased in severity from the anterior to mid stroma. The posterior stroma had grossly enlarged hyperreflective keratocytes with prominent processes. The hyperreflective particles were also seen scattered on the endothelium. ASOCT revealed a well-delineated homogenous band of increased reflectivity of approximately 70 m width in the posterior stroma of both eyes with a normal-appearing anterior and mid stroma. Corneal densitometry measured by Scheimpflug optical analysis revealed a higher amount of backscattered light from the posterior stroma with a posterior to anterior ratio of 0.8.Conclusions:In pre-Descemet membrane corneal dystrophy, although the structural changes seem to be limited to the posterior stroma as seen clinically and on ASOCT, IVCM demonstrates that the pathology is more extensive involving the entire corneal stroma and endothelium.