In vivo corneal confocal microscopic findings of palisades of Vogt and its underlying limbal stroma

Purpose: To demonstrate the corneal confocal microscopic findings of limbal palisades of Vogt and its underlying limbal stroma. Methods: Two unrelated healthy subjects (a 56-year-old man and a. 40-year-old man) with prominent palisades of Vogt were enrolled in this study. A detailed examination with confocal microscopy was performed in addition to a routine slit-lamp biomicroscopy. Cell sizes of epithelial basal layers of both the central and limbal (beneath the palisades of Vogt) were measured and statistically analyzed. Results: In both subjects, confocal microscopy in the region of the palisades of Vogt revealed normal appearance of corneal superficial layers. However, in some images, undulant basal epithelial layer was observed. In the superficial stromal layer adjacent to the corneal epithelium, we noted corneal nerves that seemed to terminate at the epithelial basal layers. The mid-stromal layers showed a highly reflective spatter-like pattern as well as numerous dark striae in a branching pattern. The corneal endothelial layer seemed normal. The average cell size of epithelial basal cells beneath the palisades of Vogt was significantly smaller than those of the central cornea (P = 0.015 and 0.005 in cases 1 and 2, respectively). Conclusions: In vivo corneal confocal microscopy is useful in observing limbal stromal microstructures. Further investigations of pathologic corneal limbus may be useful in elucidating the mechanisms contributing to corneal limbal epithelial stem cell deficiency.