Confocal microscopy investigation of the deep corneal layers

Laser assisted keratoplasty is largely used to perform minimally invasive surgery and partial thickness keratoplasty (PTK) [1-3], which can be performed through several different techniques. Such approaches are eligible with respect to the standard penetrating keratoplasty and would benefit a major comprehension of the deep stroma layers morphology, which would be crucial in identifying the correct cleavage planes. In the last years some studies were published, giving new insights about the posterior stroma morphology in adult subjects [4,5]. In this work, confocal microscopy was performed in order to investigate relevant parameters, such as different collagen types distribution. The results of this analysis show some differences in between young and adult tissues and suggest a different pattern of localization of collagen VI and I. Our results indicate the necessity of further analysing the differences between young and adult corneas and between healthy and pathological samples. Our results also suggest a developmental process in the formation of the newly identified Dua's layer, whose presence is proposed to be exploited in order to safely perform deep anterior lamellar keratoplasty (DALK) [6].