Aragona, Pasquale

Micali, Antonio

Pisani, Antonina

Puzzolo, Domenico

Roszkowska, Anna

Spinella, Rosaria

Firenze University Press: E-Journals

IJAE Vol. 115, n. 1/2 (Supplement), 2010
112
A confocal, structural and ultrastructural investigation 
on Salzmann’s nodular corneal degeneration
Antonio Micali1, Anna Roszkowska2, Rosaria Spinella2, Pasquale Aragona2, Antonina Pisani1, Dome-
nico Puzzolo1
1 Department of Biomorphology and Biotechnologies, University of Messina, Italy
2 Department of Surgical Specialties, Section of Ophthalmology, University of Messina, Italy
Salzmann’s Nodular Degeneration (SND) of the cornea is a non-inflammatory, slow-
ly progressive, generally bilateral disease, whose pathogenesis is still unknown. It is 
characterized by single or multiple whitish-gray nodules raised above the corneal sur-
face. Aim of the present work was to investigate the structure and the ultrastructure of 
an advanced SND and to correlate it to confocal in vivo findings. A forty-three years old 
man complained a progressive bilateral visual impairment during the past eight years. 
At the slit lamp examination he showed in both eyes partially confluent whitish, sub-
epithelial nodules localized in the mid periphery of the cornea: the clinical diagnosis of 
SND was made. Confocal examination with Confoscan 4 (Nidek Technologies, Italy) 
was performed before the treatment and after 1, 6 and 12 months. Thick membranes 
containing nodules were then removed manually from both eyes and they were proc-
essed for the structural and ultrastructural analysis on semithin and ultrathin sections. 
With the confocal microscope, in both examined eyes the basal epithelial cells showed 
elongated shape, especially in close proximity to the nodules. After SND removal, the 
resurfaced new epithelium exhibited at confocal regular pattern even after 12 months 
while activated keratocytes were present in the superficial stroma. At 6 months after the 
treatment, it was possible to demonstrate sub-basal nerves bundles, which appeared 
extremely thick with a well-evident tortuous course. The light and electron microscopic 
investigations demonstrated that the corneal epithelium, even if dramatically reduced 
in thickness over the nodules, showed a well-preserved morphology in all its layers, 
as it was also confirmed by the normal growth after the surgical treatment. No super-
ficial nerve bundles were detected in the stroma under the nodules. It is hypothesized 
that SND might be the final result of trophic disturbances secondary to altered corneal 
nerves distribution as a consequence of different, and yet unknown, chronic local or 
general disorders. After nodules removal, sporadic and irregular sub-basal nerves could 
be observed, as an attempt to increase the trophism of the entire cornea.
Key word
Cornea, ultrastructure, SND


A confocal, structural and ultrastructural investigation on Salzmann’s nodular corneal degeneration

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A confocal, structural and ultrastructural investigation on Salzmann’s nodular corneal degeneration

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