COMPARISON OF IN VIVO CONFOCAL MICROSCOPY AND HISTOPATHOLOGICAL FINDINGS IN PATIENTS AFTER PENETRATING KERATOPLASTY

To evaluate the concordance between in vivo confocal microscopy (IVCM) performed before penetrating keratoplasty (PK) and histopathological findings of the excised corneal buttons, and to determine whether IVCM alone may reliably substitute histopathology or whether both remain necessary for accurate pre-operative assessment.

Single-centre retrospective analysis of patients undergoing PK at the Adult Ophthalmology Department, Professor Kornel Gibiński University Clinical Centre, Medical University of Silesia, Katowice, Poland.

Twenty-four eyes with available in vivo confocal microscopy (IVCM) and histopathological data were retrospectively analysed. For each eye, the IVCM examination performed closest in time before the penetrating keratoplasty was selected. Descriptive morphological findings were standardised and converted into categorical variables (presence/absence) covering inflammation, stromal scarring, neovascularisation, Descemet’s membrane changes and endothelial alterations. Concordance between IVCM and histopathological findings was assessed as exact category match and quantified using the Jaccard similarity index. Sensitivity and precision of IVCM relative to histopathology were also calculated. The time interval between IVCM and tissue excision was recorded for each case.

The median interval between IVCM and histopathology results was approximately 190 days. Overall agreement between both modalities was moderate but clinically relevant. Inflammation showed the most consistent correspondence between IVCM and histopatology. IVCM tended to overestimate endothelial alterations, particularly in oedematous or hazy corneas, whereas deep neovascularisation and Descemet’s membrane changes were more reliably identified on histopathological evaluation. Shorter time intervals between examinations were associated with better alignment of findings.

In vivo confocal microscopy and histopathology provide complementary rather than interchangeable information in corneal assessment before penetrating keratoplasty. IVCM is particularly valuable for evaluating stromal and inflammatory changes, while histopathology remains essential for detecting deep neovascular or Descemet’s membrane alterations. Combining both modalities may offer a more comprehensive pre-operative evaluation and improve surgical planning accuracy.