PMC4859808_01
Ocular surface before and after necrotic tissue excision.. Notes: (A) Ocular surface 10 days after an acute burn. An extensive necrotic/degenerative corneoconjunctival tissue covering the entire surface is shown. (B) Under surgery microscope, a perfectly clear normal Descemet's membrane was observed.
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The entire limbus and conjunctiva were involved (Figure 1A). During this procedure, a clear and perfect corneal tissue was shown (~90% of corneal stroma was removed by curettage, leaving Descemet's membrane clearly seen in the central area; Figure 1B).
Postoperative evaluation by means of slit-lamp and corneal confocal microscopy.. Notes: (A) Postsurgery evaluation (4-5 months). On slit-lamp biomicroscopy, the cornea and anterior chamber were both clear with restored corneal stromal over the follow-up period. (B) Confocal microscopy shows epithelial and stromal regeneration with reinnervation. A normal corneal epithelium morphology with large superficial cells is seen in the regenerated epithelium. (C) Corneal nerve bundles regenerated in the corneal stroma. Anterior keratocytes and stroma were unevenly distributed, with bright nuclei and signs of opacity. (B and C) Corneal confocal microscopy was performed using Confoscan 4.0 (Nidek, Gamogori, Japan), equipped with an Achroplan non-applanating 40x immersion objective lens (Zeiss, Oberkochen, Germany). The standard dimension of each image produced was 420x315 microm (area=0.132 mm2), with an optical section thickness of 5 microm.
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The cornea appeared clear and 90%-100% corneal stromal thickness was regained (Figure 2A). To evaluate the changes in cell morphology in regenerated tissues, corneal epithelium was evaluated from the central area of regenerated cornea using confocal microscopy (Figure 2B). Anterior keratocytes and stroma were unevenly distributed, with bright nuclei and signs of opacity (Figure 2C).