In-vivo confocal microscopy study in glaucoma: a review

Aims of the present review were to provide a systematic review of the current literature on in-vivo confocal microscopy (IVCM) types, their properties and applications in glaucoma patients; to show an overview of how IVCM has improved our knowledge of corneal and conjunctival status in glaucoma patients in therapy, not treated or who have underwent filtration surgery. Review was carried out selecting relevant literature identified by an electronic search of Pubmed database on in-vivo confocal microscopy and its utility in glaucoma research using individual and combinations of key words such as “confocal”, “microscopy”, “in-vivo”, “cornea”, “conjunctiva”, “glaucoma”, “therapy”, “filtering surgery”. In-vivo confocal microscopy enables the visualization of most cornea and conjunctiva layers at a cellular level and provides an analysis both qualitative and quantitative of their status in untreated, treated glaucoma patients or after filtering glaucoma surgery. It is a non-invasive tool provided of high resolution and magnification thanks to the confocal principle. For these properties in-vivo confocal microscopy allows the detection of subclinical findings and therefore of tissue changes at much earlier stages, thus helping the evaluation of therapy management and surgery outcome. In-vivo confocal microscopy is a powerful clinical and research tool which could have several applications in the follow-up of glaucoma management. Providing an objective methodology to monitor therapy side effects and to predict surgery efficacy IVCM in future could allow to assess and tailor glaucoma treatment and could suggest specific treatments to enhance success rates of filtering surgical procedures on the basis of corneal and conjunctival morphology changes, rather than on clinical or subjective changes alone.