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Abstract: Purpose: To perform a longitudinal evaluation of subjects who had undergone penetrating keratoplasty, using slit scanning confocal microscopy. Methods: In vivo confocal microscopy was used to evaluate the central cornea of four subjects who had recently undergone penetrating keratoplasty. Subjects were examined on four occasions over a 12-month period after surgery. Quantitative and qualitative aspects of corneal morphology were compared against data from normal control subjects. Results: The epithelium varied in appearance between subjects and took at least 12 months to return to a similar arrangement to that seen in normal eyes. Bowman''s layer was viewed as an acellular layer immediately after surgery with no evidence of nerve fibres, although nerve components were apparent 12 months after surgery. Stromal nerves were not visible immediately after surgery. One year following penetrating keratoplasty there was evidence of thin nerves running a straight course through the central stroma. Keratocyte density in the anterior and posterior stroma was lower in the transplanted cornea but appeared to remain constant over a period of 1 year. Activated keratocytes were seen in the anterior stroma of all subjects; they appeared to be responsible for significant levels of corneal haze. The time period within which this keratocyte activation occurred varied between individuals. Endothelial cell density decreased at an accelerated rate over the 12-month period. Conclusions: Confocal microscopy allows cellular changes to be monitored in vivo following penetrating keratoplasty and may assist clinicians in understanding postoperative recovery. [Copyright &y& Elsevier]

Slit scanning confocal microscopy (Tomey Confoscan P4) was used to evaluate the central cornea of 22 subjects who had been wearing rigid lenses on a long-term, daily wear basis. Anterior and posterior keratocyte densities appeared unaffected by rigid lens wear (P=0.10 and 0.34 for anterior and posterior keratocyte densities, respectively). Subjects with a previous history of polymethyl methacrylate (PMMA) lens wear showed a reduction in anterior keratocyte density (AKD) (P<0.0001) and an increased level of haze in the anterior stroma. This may represent previous hypoxic damage. Endothelial cell density (ECD) was unaffected by rigid lens wear (P=0.36) although an increase in endothelial polymegethism was evident (P<0.0001). Subjects who had only worn rigid lenses with no history of PMMA lens wear did not show an increase in endothelial polymegethism (P=0.10). An increased number of microdot opacities compared to the non-lens wearing eye was apparent (P=0.05). The number of microdot opacities induced by rigid lenses, as reported in this study, appears to be less than that reported by others in respect of soft lenses. [Copyright &y& Elsevier]