In Vivo Confocal Microscopy in Presumed Central Cloudy Dystrophy of François.

A 70-years-old woman with no visual symptoms was incidentally diagnosed with presumed central cloudy dystrophy of François (CCDF) on regular ophthalmic examination. Bilateral polygonal opacities separated by clear spaces were seen in corneal biomicroscopic examination. The opacities were prominent in the central cornea and occupied full-thickness corneal stroma. Confocal microscopy revealed small highly refractile granules and deposits in the anterior and deeper stromal layers. Multiple dark acellular striae among extra-cellular matrices with increased intensities were seen in the posterior stroma. No stromal layer of keratocytes was observed. In the right eye, the corneal endothelial cell density was 3,319 cells/mm(2), polymegathism was 52.9%, and pleomorphism was 34.3%. In the left eye, endothelial cell counts could not be performed because of high stromal reflectance intensity. Full-thickness involvement of the corneal stroma with hyperreflective granules and microstriae and absence of keratocytes may represent a more advanced stage of the dystrophy.

Visante anterior segment OCT in a patient with gas bubbles in the anterior chamber after femtosecond laser corneal flap formation.

A patient with anterior chamber gas bubbles after LASIK flap formation with femtosecond laser is presented. A 33-year-old male patient had LASIK for myopia with corneal flap formation with IntraLase FS30 femtosecond laser. In the right eye, air bubbles were observed in anterior chamber after successful flap formation. Laser correction was completed successfully, by Wavelight Allegretto Wave Eye-Q excimer laser, without eye-tracker. Visante anterior segment optical coherence tomography imaging displayed that the pocket extended to limbal area, with stromal bed thickness of >600 microm at that area. We propose as possible causes of the air bubbles scattering of femtosecond laser beam producing direct photodissociation of aqueous humor, or direct cavitation effect in aqueous humor due to rapid pressure changes in corneal lamellar interface during the femtosecond laser procedure. Other causes such as migration of intrastromal bubbles through peripheral corneal stroma and trabecular meshwork, or through posterior stroma and endothelium, seem to be unlikely.