Comparison of the imaging characteristics of the basal membrane in the affected eye and the contralateral unaffected eye of patients with recurrent corneal erosion syndrome using in vivo confocal microscopy

Objective  To observe the imaging characteristics of the basement membrane in patients with recurrent corneal erosion syndrome (RCES) using in vivo confocal microscopy (IVCM), and to compare the morphological characteristics of their affected eye and contralateral unaffected eye.

Methods  An observational case series study was conducted. Thirty-six patients (72 eyes) with RCES were enrolled at Jinan Mingshui Eye Hospital from March 2023 to January 2024. IVCM was used to investigate the imaging features of the corneal erosion area of the affected eye and the peripheral basal membrane, as well as the basal membrane of the unaffected eye. This study adhered to the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of Jinan Mingshui Eye Hospital (No. 2023-013). All patients signed the written informed consent.

Results  Among the 36 patients with RCES, 24 patients (66.7%) had a history of trauma and 12 cases (33.3%) had no history of trauma; 30 cases (83.3%) had recurrent corneal erosion in one eye and 6 cases (16.7%) had alternating or simultaneous recurrent corneal erosion in both eyes, namely 42 affected eyes and 30 unaffected eyes. Through IVCM observation, the basal membrane of the unaffected eye had similar abnormal structural characteristics to the peripheral basal membrane of the affected eye, and various abnormal structures of the basement membrane often appeared in combination. In the 30 contralateral healthy eyes, only 2 eyes showed no abnormal changes, while the remaining 28 eyes showed the same abnormal morphology as the peripheral basal membrane of the affected eye, either alone or in combination. In the 42 affected eyes, 6 eyes (14.3%) showed uniform hyperreflectivity of basal membrane, 10 eyes (23.8%) had bleb-like structures, 10 eyes (23.8%) had net structures, 5 eyes (11.9%) had islets of intracellular accumulation, 8 eyes (19.0%) had map-like structures, 2 eyes (4.8%) had fingerprint-like changes, and 9 eyes (21.4%) had no obvious abnormal structures. In the 30 contralateral unaffected eyes, 6 eyes (20.0%) showed uniform hyperreflectivity of basal membrane, 16 eyes (53.3%) had bleb-like structures, 10 eyes (33.3%) had net structures, 2 eyes (6.7%) had islets of intracellular accumulation, 5 eyes (16.7%) had map-like structures, 2 eyes (6.7%) had oval cystic changes, and 2 eyes (6.7%) had no obvious abnormal structures. Additionally, in both the affected eyes and the contralateral unaffected eyes, some bleb-like structures were found to be connected to the subbasal nerve fibers.

Conclusions  Through IVCM observation, the contralateral unaffected eyes of RCES patients exhibit similar characteristic microscopic structural changes to those of the affected eyes.