Corneal Involvement In Primary Biliary Cirrhosis : An In Vivo Confocal Microscopy Study

Purpose:To investigate the corneal involvement in Primary Biliary Cirrhosis (PBC), a slowly progressive cholestatic liver disease of autoimmune etiology. Methods:Seven female patients affected by PBC underwent a slit-lamp biomicroscopy of the anterior segment with and without Goldmann's three-mirror contact lens, and laser scanning confocal microscopy (LSCM, Heidelberg Engineering Germany). LSCM images were acquired and analyzed for all layers of central and peripheral cornea (four quadrants). Results:All patients had normal findings both at slit-lamp biomicroscopy and at gonioscopy. Peculiar findings were shown at LSCM: all patients showed keratocytes activation (Figure 1); sub-basal nerve fibers with beadlike structure (Figure 2) were found in six patients (86%); four subjects (57%) had hyper-reflective stromal macro-deposits (Figure 2). No deposits suggestive for copper deposition were detected at the level of Descemet’s membrane. Conclusions:To the best of our knowledge this is the first confocal microscopy study on PBC patients. LSCM could show that subclinical corneal inflammation is a very common finding also in ophthalmoscopically normal patients affected by this autoimmune disease.