SlideShare a Scribd company logo
1 of 14
CONFOCAL
MICROSCOPY
By:
Noor Munirah bt Awang Abu Bakar
P82498
Confocal microscopy-Outline
Introduction: What is confocal microscopy
Clinical use of confocal microscopy
Type of confocal microscopy available
Confoscan 4
Optic of confocal microscopy
Anatomy of cornea layer
Intro: Confocal microscopy
 A non-invasive histological imaging technique to demonstrate the
characteristic of corneal and conjunctival anatomy in vivo at the
cellular level.
 Use reflected light from the living tissue. Therefore, it is an in vivo
imaging method of the living cornea.
 Record normal corneal innervation and cell distribution, as well as
changes associated with age, contact lens wear and systemic disease
such as diabetes.
(Elisabeth, 2008)
Clinical use
 Observation and characterization of the corneal layers and cells
 Detection and Management of Corneal Dystrophies & Ectasies
 Detection and Management of Pathologic Infectious Conditions
 Pre and post surgical evaluation (PRK, LASIK and LASEK, flap
evaluations and Radial Keratotomy)
 Monitoring contact lens induced corneal changes
 Diagnosing Peripheral Neuropathies
 Penetrating keratoplasty
Type of confocal microscope
 Four types of confocal microscopes are commercially available:
1. Confocal laser scanning microscopes
use multiple mirrors (typically 2 or 3 scanning linearly along the x and the
y axis) to scan the laser across the sample and "descan" the image across a
fixed pinhole and detector.
Example: Confoscan 4 by NIDEK
2. Spinning-disk (Nipkow disk) confocal microscopes
3. Microlens enhanced or dual spinning disk confocal microscopes
4. Programmable array microscopes (PAM)
Confoscan 4
 The only instrument that combines confocal microscopy, endothelial
microscopy and accurate pachymetry in one compact unit.
 High Precision
 Wider measurement area (up to 1000 cells/exam)
 Full cornea, endothelium or epithelium scan
 Fully automatic cell count and endothelial density measurement
 Confocal Microscope with 40X Probe or 20X probe
 Gel immersion exam
 Examination time below 15 sec.
 Fully non-contact (12 mm working distance in air)
 High quality imaging through corneal haze and opacities
 ±5 microns instrumental accuracy
Optic of confocal microscopy
1. It uses focused light or laser beam.
2. A bright light beam is projected and focused through an objective lens to the cornea.
3. Then reflected light spot is collected from the illuminated tissue area by objective lens.
4. With the help of beam splitter, reflected light is separated from the light mixture and directed to the
detection unit.
5. Reflected light reaches to the detection apparatus by passing a pinhole.
6. The pin-hole at the entrance of detector apparatus filters the light coming from outside the intended
focal point. This filtration helps grabbing sharper and clearer images than conventional light microscopy.
7. Detector transcodes the reflected light into electrical signal and records to the storage media.
Anatomy of corneal layer
 Cornea is a transparent and avascular layer of
the eye that cover front part of the eye.
 Funtion: To refract or bend and focusing light
that enters the eye.
 Consists of 5 layers
 Corneal epithelium
 Bowman’s layer
 Corneal stroma
 Descemet’s membrane
 Corneal endothelium
Anatomy of corneal layer –
1. Epithelium
Superficialcells
• Depth 0 μm,
~50mm in diameter
• Density ~850
cells/mm2
• Bright cell borders
and a dark nucleus
& cytoplasm are
readily visualized
• Shape: often
hexagonal
Wingcells
• Depth 20 μm,
~20mm in diameter
• Density ~5,000
cells/mm2
• Bright cell borders
and a dark
cytoplasm
• Shape: minimal
variation shape &
size
Basalcells
• Depth 30 μm,
~10µm in diameter
• Density ~9,000
cells/mm2
• Bright cell borders
and nucleus not
visible
• Shape: minimal
variation shape &
size
Anatomy of corneal layer
No Corneal layer Confocal image
2. Bowman’s layer
• An acellular layer
• 8-14 µm thick
• Composed of randomly arranged collagen fibers (finer than
those found in corneal stroma, continuous with anterior
stroma.
• Resistant to trauma.
• Cannot be regenerated if destroyed
3. Stroma layer
• Thickness: 0.5 mm,
• 90 % of total corneal thickness
• Consists of collagen fibrils (lamellae) and cells embedded in
hydrated matrix of proteoglycans (ground substance).
• Lamellae arranged parallelly (200 – 250 layers)
• Cells: keratocytes
< Anterior stroma
Posterior stroma>
Anatomy of corneal layer
No Corneal layer Confocal image
4. Descemet membrane
• Represents the basement membrane of the endothelium
• Made up of collagen and glycoprotein
• Thickness :10-12 µm
• Very resistant to chemical agents, trauma, infection and pathological
processes, can regenerate, when destroyed.
• Maintains integrity of the eyeball,
• Images with CM-hazy appearance and no cellular structures can be
identified.
• Normal Descemet’s membrane is not visible in young subjects, becomes
more visible with increasing age (Hollingsworth, 2001)
5. Endothelial
• Single layer of flat hexagonal cells, Mosaic pattern
• Bright cell bodies with dark cell borders
• 4-6 mm thick, 20µm in diameter
• Cell density: 2400-3000cells/mm2
• Contains active pump mechanism
• Best evaluated by specular microscopy
Example
Fuch’s
dystrophy
Keratoconus with no
CL wear
Keratoconus associated with
RGP wear
Conclusion
 The introduction of in vivo confocal microscopy into the research and
clinical practice is a revolutionary approach for both inherited or
acquired corneal diseases.
 Able to demonstrate the characteristic corneal and conjunctival
anatomy at the cellular level.
 It allowed the clinician in vivo microscopic analysis of
 affected corneas like corneal guttata and Fuch dystrophy
 wound healing response after refractive surgery
 screening of unaffected family members.
References:
 Elisabeth M. Messmer,E.M. Confocal Microscopy: When Is it Helpful to Diagnose Corneal and
Conjunctival Disease?.Rev Ophthalmol. 2008;3(2):177-192.
 Hollingsworth J, Perez-Gomez I, Mutalib HA, et al. A population study of the normal cornea using
an in vivo, slit-scanning confocal microscope. Optometry and Vision Science. 2001;78:706–11.
 Umit Yolcu, Omer Faruk Sahin and Fatih C. Gundogan (2014). Imaging in Ophthalmology,
Ophthalmology - Current Clinical and Research Updates, Associate Prof. Pinakin Davey (Ed.), ISBN:
978-953-51-1721-6, InTech, DOI: 10.5772/58314. Available from:
http://www.intechopen.com/books/ophthalmology-current-clinical-and-research-updates/imaging-in-
ophthalmology

More Related Content

What's hot

Confocal microscopy by prabhat
Confocal microscopy by prabhatConfocal microscopy by prabhat
Confocal microscopy by prabhatPrabhat Kumar
 
Confocal microscope presentation pt
Confocal microscope presentation  ptConfocal microscope presentation  pt
Confocal microscope presentation ptShrigouri4605
 
Different types of microscopes
Different types of microscopesDifferent types of microscopes
Different types of microscopesUTTAM KUMAR DAS
 
Confocal laser scanning microscopy (clsm)
Confocal laser scanning microscopy (clsm)Confocal laser scanning microscopy (clsm)
Confocal laser scanning microscopy (clsm)Nethravathi Siri
 
Fluorescence microscope
Fluorescence microscopeFluorescence microscope
Fluorescence microscopeLeyon Raj
 
Corneal confocal microscopy
Corneal confocal microscopyCorneal confocal microscopy
Corneal confocal microscopyDiyarAlzubaidy
 
What is Relex SMILE
What is Relex SMILEWhat is Relex SMILE
What is Relex SMILESavio Vaz
 
Differential Interference Contrast Microscope.pptx
Differential Interference Contrast Microscope.pptxDifferential Interference Contrast Microscope.pptx
Differential Interference Contrast Microscope.pptxAdityaSharma772610
 
Art of iris repair ppt
Art of iris repair pptArt of iris repair ppt
Art of iris repair pptDiyarAlzubaidy
 
Confocal microscopy of the eye
Confocal microscopy of the eyeConfocal microscopy of the eye
Confocal microscopy of the eyeRohit Rao
 
Electron microscope (TEM & SEM)
Electron microscope (TEM & SEM)Electron microscope (TEM & SEM)
Electron microscope (TEM & SEM)Subhankar Das
 
Limbal Stem Cell Deficiency & its management
Limbal Stem Cell Deficiency & its  managementLimbal Stem Cell Deficiency & its  management
Limbal Stem Cell Deficiency & its managementKaran Bhatia
 
Fluorescence microscope by Subhankar Das
Fluorescence microscope by Subhankar DasFluorescence microscope by Subhankar Das
Fluorescence microscope by Subhankar DasSubhankar Das
 

What's hot (20)

Confocal microscopy by prabhat
Confocal microscopy by prabhatConfocal microscopy by prabhat
Confocal microscopy by prabhat
 
Confocal microscope presentation pt
Confocal microscope presentation  ptConfocal microscope presentation  pt
Confocal microscope presentation pt
 
Different types of microscopes
Different types of microscopesDifferent types of microscopes
Different types of microscopes
 
Confocal laser scanning microscopy (clsm)
Confocal laser scanning microscopy (clsm)Confocal laser scanning microscopy (clsm)
Confocal laser scanning microscopy (clsm)
 
Light Microscopy
Light MicroscopyLight Microscopy
Light Microscopy
 
Confocal microscopy
Confocal microscopyConfocal microscopy
Confocal microscopy
 
Fluorescence microscope
Fluorescence microscopeFluorescence microscope
Fluorescence microscope
 
Corneal confocal microscopy
Corneal confocal microscopyCorneal confocal microscopy
Corneal confocal microscopy
 
Study of Microscopy.
Study of Microscopy.Study of Microscopy.
Study of Microscopy.
 
Electron microscopy (EM)
Electron microscopy (EM) Electron microscopy (EM)
Electron microscopy (EM)
 
What is Relex SMILE
What is Relex SMILEWhat is Relex SMILE
What is Relex SMILE
 
Differential Interference Contrast Microscope.pptx
Differential Interference Contrast Microscope.pptxDifferential Interference Contrast Microscope.pptx
Differential Interference Contrast Microscope.pptx
 
Art of iris repair ppt
Art of iris repair pptArt of iris repair ppt
Art of iris repair ppt
 
Lens aberration
Lens aberrationLens aberration
Lens aberration
 
Confocal microscopy of the eye
Confocal microscopy of the eyeConfocal microscopy of the eye
Confocal microscopy of the eye
 
Electron microscope (TEM & SEM)
Electron microscope (TEM & SEM)Electron microscope (TEM & SEM)
Electron microscope (TEM & SEM)
 
Light microscope
Light microscopeLight microscope
Light microscope
 
Light microscopy
Light microscopyLight microscopy
Light microscopy
 
Limbal Stem Cell Deficiency & its management
Limbal Stem Cell Deficiency & its  managementLimbal Stem Cell Deficiency & its  management
Limbal Stem Cell Deficiency & its management
 
Fluorescence microscope by Subhankar Das
Fluorescence microscope by Subhankar DasFluorescence microscope by Subhankar Das
Fluorescence microscope by Subhankar Das
 

Similar to Confocal microscopy

Assessment of corneal endothelium
Assessment of corneal endotheliumAssessment of corneal endothelium
Assessment of corneal endotheliumReshma Shaji
 
Assessment of corneal endothelium
Assessment of corneal endotheliumAssessment of corneal endothelium
Assessment of corneal endotheliumanudeep kannegolla
 
Assessment of corneal endothelium
Assessment of corneal endotheliumAssessment of corneal endothelium
Assessment of corneal endotheliumdrvasant162
 
Optical Coherence Tomography (OCT)
Optical Coherence Tomography (OCT)Optical Coherence Tomography (OCT)
Optical Coherence Tomography (OCT)ShrutiDagar1
 
ELECTRON MICROSCOPE-1.pptx
ELECTRON MICROSCOPE-1.pptxELECTRON MICROSCOPE-1.pptx
ELECTRON MICROSCOPE-1.pptxOpenPhone
 
Oct in post seg disorders
Oct in post seg disordersOct in post seg disorders
Oct in post seg disordersDinesh Madduri
 
Optical coherence tomography in multiple sclerosis
Optical coherence tomography in multiple sclerosisOptical coherence tomography in multiple sclerosis
Optical coherence tomography in multiple sclerosisAhmed Mamdouh
 
slit lamp photography.pdf
slit lamp photography.pdfslit lamp photography.pdf
slit lamp photography.pdfMusabFathallah
 
OCT – Introduction and Macular disorders
OCT – Introduction and Macular disordersOCT – Introduction and Macular disorders
OCT – Introduction and Macular disordersSajjan Sangai
 
Examination of the cornea by Dr. Iddi Ndyabawe
Examination of the cornea by Dr. Iddi NdyabaweExamination of the cornea by Dr. Iddi Ndyabawe
Examination of the cornea by Dr. Iddi NdyabaweIddi Ndyabawe
 
Cornea- Anatomy & Physiology.pptx
Cornea- Anatomy & Physiology.pptxCornea- Anatomy & Physiology.pptx
Cornea- Anatomy & Physiology.pptxAyurgyan2077
 
Keratoprosthesis
KeratoprosthesisKeratoprosthesis
Keratoprosthesispeterroy90
 
OCT , Laser therapy for DR , Vitrectomy
OCT , Laser therapy for DR , VitrectomyOCT , Laser therapy for DR , Vitrectomy
OCT , Laser therapy for DR , VitrectomyAl Amin
 
Optical Coherence Tomography(OCT) in posterior segment diseases
Optical Coherence Tomography(OCT) in posterior segment diseasesOptical Coherence Tomography(OCT) in posterior segment diseases
Optical Coherence Tomography(OCT) in posterior segment diseasesShagil Khan
 

Similar to Confocal microscopy (20)

Assessment of corneal endothelium
Assessment of corneal endotheliumAssessment of corneal endothelium
Assessment of corneal endothelium
 
Assessment of corneal endothelium
Assessment of corneal endotheliumAssessment of corneal endothelium
Assessment of corneal endothelium
 
Assessment of corneal endothelium
Assessment of corneal endotheliumAssessment of corneal endothelium
Assessment of corneal endothelium
 
Optical Coherence Tomography (OCT)
Optical Coherence Tomography (OCT)Optical Coherence Tomography (OCT)
Optical Coherence Tomography (OCT)
 
ELECTRON MICROSCOPE-1.pptx
ELECTRON MICROSCOPE-1.pptxELECTRON MICROSCOPE-1.pptx
ELECTRON MICROSCOPE-1.pptx
 
Oct in post seg disorders
Oct in post seg disordersOct in post seg disorders
Oct in post seg disorders
 
Oct introduction
Oct  introductionOct  introduction
Oct introduction
 
Optical coherence tomography in multiple sclerosis
Optical coherence tomography in multiple sclerosisOptical coherence tomography in multiple sclerosis
Optical coherence tomography in multiple sclerosis
 
slit lamp photography.pdf
slit lamp photography.pdfslit lamp photography.pdf
slit lamp photography.pdf
 
OCT – Introduction and Macular disorders
OCT – Introduction and Macular disordersOCT – Introduction and Macular disorders
OCT – Introduction and Macular disorders
 
Examination of the cornea by Dr. Iddi Ndyabawe
Examination of the cornea by Dr. Iddi NdyabaweExamination of the cornea by Dr. Iddi Ndyabawe
Examination of the cornea by Dr. Iddi Ndyabawe
 
Cornea- Anatomy & Physiology.pptx
Cornea- Anatomy & Physiology.pptxCornea- Anatomy & Physiology.pptx
Cornea- Anatomy & Physiology.pptx
 
Keratoprosthesis
KeratoprosthesisKeratoprosthesis
Keratoprosthesis
 
OCT , Laser therapy for DR , Vitrectomy
OCT , Laser therapy for DR , VitrectomyOCT , Laser therapy for DR , Vitrectomy
OCT , Laser therapy for DR , Vitrectomy
 
Sl exam pt i
Sl exam pt iSl exam pt i
Sl exam pt i
 
OCT
OCTOCT
OCT
 
Catract
CatractCatract
Catract
 
Histo tool.pptx
Histo tool.pptxHisto tool.pptx
Histo tool.pptx
 
Histological tools
Histological toolsHistological tools
Histological tools
 
Optical Coherence Tomography(OCT) in posterior segment diseases
Optical Coherence Tomography(OCT) in posterior segment diseasesOptical Coherence Tomography(OCT) in posterior segment diseases
Optical Coherence Tomography(OCT) in posterior segment diseases
 

More from Noor Munirah Aab

Biometry: Iol calculation
Biometry: Iol calculation Biometry: Iol calculation
Biometry: Iol calculation Noor Munirah Aab
 
Pseudophakic Bullous Keratopathy case
Pseudophakic Bullous Keratopathy case Pseudophakic Bullous Keratopathy case
Pseudophakic Bullous Keratopathy case Noor Munirah Aab
 
Case study: Sixth Nerve Palsy (Optometric Management)
Case study: Sixth Nerve Palsy (Optometric Management)Case study: Sixth Nerve Palsy (Optometric Management)
Case study: Sixth Nerve Palsy (Optometric Management)Noor Munirah Aab
 
AION Anterior Ischemic Optic Neuropathy
AION Anterior Ischemic Optic NeuropathyAION Anterior Ischemic Optic Neuropathy
AION Anterior Ischemic Optic NeuropathyNoor Munirah Aab
 
Fixation characteristics and abnormalities
Fixation characteristics and abnormalitiesFixation characteristics and abnormalities
Fixation characteristics and abnormalitiesNoor Munirah Aab
 
Contact lens for Keratoconus case study
Contact lens for Keratoconus case studyContact lens for Keratoconus case study
Contact lens for Keratoconus case studyNoor Munirah Aab
 
Ill-sustained accommodation
Ill-sustained accommodationIll-sustained accommodation
Ill-sustained accommodationNoor Munirah Aab
 
Contact lens complication
Contact lens complication Contact lens complication
Contact lens complication Noor Munirah Aab
 

More from Noor Munirah Aab (13)

Biometry: Iol calculation
Biometry: Iol calculation Biometry: Iol calculation
Biometry: Iol calculation
 
Pseudophakic Bullous Keratopathy case
Pseudophakic Bullous Keratopathy case Pseudophakic Bullous Keratopathy case
Pseudophakic Bullous Keratopathy case
 
Holladay2
Holladay2Holladay2
Holladay2
 
Bacterial keratitis
Bacterial keratitis Bacterial keratitis
Bacterial keratitis
 
Case study: Sixth Nerve Palsy (Optometric Management)
Case study: Sixth Nerve Palsy (Optometric Management)Case study: Sixth Nerve Palsy (Optometric Management)
Case study: Sixth Nerve Palsy (Optometric Management)
 
Sixth nerve palsy
Sixth nerve palsySixth nerve palsy
Sixth nerve palsy
 
Scleral lenses
Scleral lensesScleral lenses
Scleral lenses
 
AION Anterior Ischemic Optic Neuropathy
AION Anterior Ischemic Optic NeuropathyAION Anterior Ischemic Optic Neuropathy
AION Anterior Ischemic Optic Neuropathy
 
Fixation characteristics and abnormalities
Fixation characteristics and abnormalitiesFixation characteristics and abnormalities
Fixation characteristics and abnormalities
 
Contact lens for Keratoconus case study
Contact lens for Keratoconus case studyContact lens for Keratoconus case study
Contact lens for Keratoconus case study
 
Ill-sustained accommodation
Ill-sustained accommodationIll-sustained accommodation
Ill-sustained accommodation
 
Pediatric contact lens
Pediatric contact lensPediatric contact lens
Pediatric contact lens
 
Contact lens complication
Contact lens complication Contact lens complication
Contact lens complication
 

Recently uploaded

Low Rate Call Girls In Bommanahalli Just Call 7001305949
Low Rate Call Girls In Bommanahalli Just Call 7001305949Low Rate Call Girls In Bommanahalli Just Call 7001305949
Low Rate Call Girls In Bommanahalli Just Call 7001305949ps5894268
 
College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...
College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...
College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...delhimodelshub1
 
Russian Call Girl Chandapura Dommasandra Road - 7001305949 Escorts Service 50...
Russian Call Girl Chandapura Dommasandra Road - 7001305949 Escorts Service 50...Russian Call Girl Chandapura Dommasandra Road - 7001305949 Escorts Service 50...
Russian Call Girl Chandapura Dommasandra Road - 7001305949 Escorts Service 50...narwatsonia7
 
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of Hospital A...
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of  Hospital A...Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of  Hospital A...
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of Hospital A...Era University , Lucknow
 
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near MeBook Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Menarwatsonia7
 
Gurgaon iffco chowk 🔝 Call Girls Service 🔝 ( 8264348440 ) unlimited hard sex ...
Gurgaon iffco chowk 🔝 Call Girls Service 🔝 ( 8264348440 ) unlimited hard sex ...Gurgaon iffco chowk 🔝 Call Girls Service 🔝 ( 8264348440 ) unlimited hard sex ...
Gurgaon iffco chowk 🔝 Call Girls Service 🔝 ( 8264348440 ) unlimited hard sex ...soniya singh
 
Globalny raport: „Prawdziwe piękno 2024" od Dove
Globalny raport: „Prawdziwe piękno 2024" od DoveGlobalny raport: „Prawdziwe piękno 2024" od Dove
Globalny raport: „Prawdziwe piękno 2024" od Doveagatadrynko
 
Call Girls in Adil Nagar 7001305949 Free Delivery at Your Door Model
Call Girls in Adil Nagar 7001305949 Free Delivery at Your Door ModelCall Girls in Adil Nagar 7001305949 Free Delivery at Your Door Model
Call Girls in Adil Nagar 7001305949 Free Delivery at Your Door ModelCall Girls Lucknow
 
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...satishsharma69855
 
Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...
Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...
Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...scanFOAM
 
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment BookingRussian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Soft Toric contact lens fitting (NSO).pptx
Soft Toric contact lens fitting (NSO).pptxSoft Toric contact lens fitting (NSO).pptx
Soft Toric contact lens fitting (NSO).pptxJasmin Modi
 
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...sandeepkumar69420
 
Russian Call Girls Hyderabad Saloni 9907093804 Independent Escort Service Hyd...
Russian Call Girls Hyderabad Saloni 9907093804 Independent Escort Service Hyd...Russian Call Girls Hyderabad Saloni 9907093804 Independent Escort Service Hyd...
Russian Call Girls Hyderabad Saloni 9907093804 Independent Escort Service Hyd...delhimodelshub1
 
Russian Escorts Delhi | 9711199171 | all area service available
Russian Escorts Delhi | 9711199171 | all area service availableRussian Escorts Delhi | 9711199171 | all area service available
Russian Escorts Delhi | 9711199171 | all area service availablesandeepkumar69420
 
Call Girls Secunderabad 7001305949 all area service COD available Any Time
Call Girls Secunderabad 7001305949 all area service COD available Any TimeCall Girls Secunderabad 7001305949 all area service COD available Any Time
Call Girls Secunderabad 7001305949 all area service COD available Any Timedelhimodelshub1
 
FAMILY in sociology for physiotherapists.pptx
FAMILY in sociology for physiotherapists.pptxFAMILY in sociology for physiotherapists.pptx
FAMILY in sociology for physiotherapists.pptxMumux Mirani
 
2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology InsightsHealth Catalyst
 
Russian Call Girls in Goa Samaira 7001305949 Independent Escort Service Goa
Russian Call Girls in Goa Samaira 7001305949 Independent Escort Service GoaRussian Call Girls in Goa Samaira 7001305949 Independent Escort Service Goa
Russian Call Girls in Goa Samaira 7001305949 Independent Escort Service Goanarwatsonia7
 
Call Girls Dwarka 9999965857 Cheap & Best with original Photos
Call Girls Dwarka 9999965857 Cheap & Best with original PhotosCall Girls Dwarka 9999965857 Cheap & Best with original Photos
Call Girls Dwarka 9999965857 Cheap & Best with original Photosparshadkalavatidevi7
 

Recently uploaded (20)

Low Rate Call Girls In Bommanahalli Just Call 7001305949
Low Rate Call Girls In Bommanahalli Just Call 7001305949Low Rate Call Girls In Bommanahalli Just Call 7001305949
Low Rate Call Girls In Bommanahalli Just Call 7001305949
 
College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...
College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...
College Call Girls Hyderabad Sakshi 9907093804 Independent Escort Service Hyd...
 
Russian Call Girl Chandapura Dommasandra Road - 7001305949 Escorts Service 50...
Russian Call Girl Chandapura Dommasandra Road - 7001305949 Escorts Service 50...Russian Call Girl Chandapura Dommasandra Road - 7001305949 Escorts Service 50...
Russian Call Girl Chandapura Dommasandra Road - 7001305949 Escorts Service 50...
 
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of Hospital A...
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of  Hospital A...Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of  Hospital A...
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of Hospital A...
 
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near MeBook Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
 
Gurgaon iffco chowk 🔝 Call Girls Service 🔝 ( 8264348440 ) unlimited hard sex ...
Gurgaon iffco chowk 🔝 Call Girls Service 🔝 ( 8264348440 ) unlimited hard sex ...Gurgaon iffco chowk 🔝 Call Girls Service 🔝 ( 8264348440 ) unlimited hard sex ...
Gurgaon iffco chowk 🔝 Call Girls Service 🔝 ( 8264348440 ) unlimited hard sex ...
 
Globalny raport: „Prawdziwe piękno 2024" od Dove
Globalny raport: „Prawdziwe piękno 2024" od DoveGlobalny raport: „Prawdziwe piękno 2024" od Dove
Globalny raport: „Prawdziwe piękno 2024" od Dove
 
Call Girls in Adil Nagar 7001305949 Free Delivery at Your Door Model
Call Girls in Adil Nagar 7001305949 Free Delivery at Your Door ModelCall Girls in Adil Nagar 7001305949 Free Delivery at Your Door Model
Call Girls in Adil Nagar 7001305949 Free Delivery at Your Door Model
 
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
 
Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...
Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...
Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...
 
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment BookingRussian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
 
Soft Toric contact lens fitting (NSO).pptx
Soft Toric contact lens fitting (NSO).pptxSoft Toric contact lens fitting (NSO).pptx
Soft Toric contact lens fitting (NSO).pptx
 
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
 
Russian Call Girls Hyderabad Saloni 9907093804 Independent Escort Service Hyd...
Russian Call Girls Hyderabad Saloni 9907093804 Independent Escort Service Hyd...Russian Call Girls Hyderabad Saloni 9907093804 Independent Escort Service Hyd...
Russian Call Girls Hyderabad Saloni 9907093804 Independent Escort Service Hyd...
 
Russian Escorts Delhi | 9711199171 | all area service available
Russian Escorts Delhi | 9711199171 | all area service availableRussian Escorts Delhi | 9711199171 | all area service available
Russian Escorts Delhi | 9711199171 | all area service available
 
Call Girls Secunderabad 7001305949 all area service COD available Any Time
Call Girls Secunderabad 7001305949 all area service COD available Any TimeCall Girls Secunderabad 7001305949 all area service COD available Any Time
Call Girls Secunderabad 7001305949 all area service COD available Any Time
 
FAMILY in sociology for physiotherapists.pptx
FAMILY in sociology for physiotherapists.pptxFAMILY in sociology for physiotherapists.pptx
FAMILY in sociology for physiotherapists.pptx
 
2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights
 
Russian Call Girls in Goa Samaira 7001305949 Independent Escort Service Goa
Russian Call Girls in Goa Samaira 7001305949 Independent Escort Service GoaRussian Call Girls in Goa Samaira 7001305949 Independent Escort Service Goa
Russian Call Girls in Goa Samaira 7001305949 Independent Escort Service Goa
 
Call Girls Dwarka 9999965857 Cheap & Best with original Photos
Call Girls Dwarka 9999965857 Cheap & Best with original PhotosCall Girls Dwarka 9999965857 Cheap & Best with original Photos
Call Girls Dwarka 9999965857 Cheap & Best with original Photos
 

Confocal microscopy

  • 2. Confocal microscopy-Outline Introduction: What is confocal microscopy Clinical use of confocal microscopy Type of confocal microscopy available Confoscan 4 Optic of confocal microscopy Anatomy of cornea layer
  • 3. Intro: Confocal microscopy  A non-invasive histological imaging technique to demonstrate the characteristic of corneal and conjunctival anatomy in vivo at the cellular level.  Use reflected light from the living tissue. Therefore, it is an in vivo imaging method of the living cornea.  Record normal corneal innervation and cell distribution, as well as changes associated with age, contact lens wear and systemic disease such as diabetes. (Elisabeth, 2008)
  • 4. Clinical use  Observation and characterization of the corneal layers and cells  Detection and Management of Corneal Dystrophies & Ectasies  Detection and Management of Pathologic Infectious Conditions  Pre and post surgical evaluation (PRK, LASIK and LASEK, flap evaluations and Radial Keratotomy)  Monitoring contact lens induced corneal changes  Diagnosing Peripheral Neuropathies  Penetrating keratoplasty
  • 5. Type of confocal microscope  Four types of confocal microscopes are commercially available: 1. Confocal laser scanning microscopes use multiple mirrors (typically 2 or 3 scanning linearly along the x and the y axis) to scan the laser across the sample and "descan" the image across a fixed pinhole and detector. Example: Confoscan 4 by NIDEK 2. Spinning-disk (Nipkow disk) confocal microscopes 3. Microlens enhanced or dual spinning disk confocal microscopes 4. Programmable array microscopes (PAM)
  • 6. Confoscan 4  The only instrument that combines confocal microscopy, endothelial microscopy and accurate pachymetry in one compact unit.  High Precision  Wider measurement area (up to 1000 cells/exam)  Full cornea, endothelium or epithelium scan  Fully automatic cell count and endothelial density measurement  Confocal Microscope with 40X Probe or 20X probe  Gel immersion exam  Examination time below 15 sec.  Fully non-contact (12 mm working distance in air)  High quality imaging through corneal haze and opacities  ±5 microns instrumental accuracy
  • 7. Optic of confocal microscopy 1. It uses focused light or laser beam. 2. A bright light beam is projected and focused through an objective lens to the cornea. 3. Then reflected light spot is collected from the illuminated tissue area by objective lens. 4. With the help of beam splitter, reflected light is separated from the light mixture and directed to the detection unit. 5. Reflected light reaches to the detection apparatus by passing a pinhole. 6. The pin-hole at the entrance of detector apparatus filters the light coming from outside the intended focal point. This filtration helps grabbing sharper and clearer images than conventional light microscopy. 7. Detector transcodes the reflected light into electrical signal and records to the storage media.
  • 8. Anatomy of corneal layer  Cornea is a transparent and avascular layer of the eye that cover front part of the eye.  Funtion: To refract or bend and focusing light that enters the eye.  Consists of 5 layers  Corneal epithelium  Bowman’s layer  Corneal stroma  Descemet’s membrane  Corneal endothelium
  • 9. Anatomy of corneal layer – 1. Epithelium Superficialcells • Depth 0 μm, ~50mm in diameter • Density ~850 cells/mm2 • Bright cell borders and a dark nucleus & cytoplasm are readily visualized • Shape: often hexagonal Wingcells • Depth 20 μm, ~20mm in diameter • Density ~5,000 cells/mm2 • Bright cell borders and a dark cytoplasm • Shape: minimal variation shape & size Basalcells • Depth 30 μm, ~10µm in diameter • Density ~9,000 cells/mm2 • Bright cell borders and nucleus not visible • Shape: minimal variation shape & size
  • 10. Anatomy of corneal layer No Corneal layer Confocal image 2. Bowman’s layer • An acellular layer • 8-14 µm thick • Composed of randomly arranged collagen fibers (finer than those found in corneal stroma, continuous with anterior stroma. • Resistant to trauma. • Cannot be regenerated if destroyed 3. Stroma layer • Thickness: 0.5 mm, • 90 % of total corneal thickness • Consists of collagen fibrils (lamellae) and cells embedded in hydrated matrix of proteoglycans (ground substance). • Lamellae arranged parallelly (200 – 250 layers) • Cells: keratocytes < Anterior stroma Posterior stroma>
  • 11. Anatomy of corneal layer No Corneal layer Confocal image 4. Descemet membrane • Represents the basement membrane of the endothelium • Made up of collagen and glycoprotein • Thickness :10-12 µm • Very resistant to chemical agents, trauma, infection and pathological processes, can regenerate, when destroyed. • Maintains integrity of the eyeball, • Images with CM-hazy appearance and no cellular structures can be identified. • Normal Descemet’s membrane is not visible in young subjects, becomes more visible with increasing age (Hollingsworth, 2001) 5. Endothelial • Single layer of flat hexagonal cells, Mosaic pattern • Bright cell bodies with dark cell borders • 4-6 mm thick, 20µm in diameter • Cell density: 2400-3000cells/mm2 • Contains active pump mechanism • Best evaluated by specular microscopy
  • 12. Example Fuch’s dystrophy Keratoconus with no CL wear Keratoconus associated with RGP wear
  • 13. Conclusion  The introduction of in vivo confocal microscopy into the research and clinical practice is a revolutionary approach for both inherited or acquired corneal diseases.  Able to demonstrate the characteristic corneal and conjunctival anatomy at the cellular level.  It allowed the clinician in vivo microscopic analysis of  affected corneas like corneal guttata and Fuch dystrophy  wound healing response after refractive surgery  screening of unaffected family members.
  • 14. References:  Elisabeth M. Messmer,E.M. Confocal Microscopy: When Is it Helpful to Diagnose Corneal and Conjunctival Disease?.Rev Ophthalmol. 2008;3(2):177-192.  Hollingsworth J, Perez-Gomez I, Mutalib HA, et al. A population study of the normal cornea using an in vivo, slit-scanning confocal microscope. Optometry and Vision Science. 2001;78:706–11.  Umit Yolcu, Omer Faruk Sahin and Fatih C. Gundogan (2014). Imaging in Ophthalmology, Ophthalmology - Current Clinical and Research Updates, Associate Prof. Pinakin Davey (Ed.), ISBN: 978-953-51-1721-6, InTech, DOI: 10.5772/58314. Available from: http://www.intechopen.com/books/ophthalmology-current-clinical-and-research-updates/imaging-in- ophthalmology