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Ex vivo confocal microscopy of human corneal nerves
  1. Mouhamed A Al-Aqaba,
  2. Thaer Alomar,
  3. Ammar Miri,
  4. Usama Fares,
  5. Ahmad Muneer Otri,
  6. Harmnider S Dua
  1. Division of Ophthalmology and Visual Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
  1. Correspondence to Professor Harminder S Dua, Division of Ophthalmology and Visual Sciences, B Floor, Eye and ENT Centre, Queen's Medical Centre, University Hospital, Derby Road, Nottingham NG7 2UH, UK; Harminder.dua{at}


Aims To evaluate the distribution, morphometry and the postmortem changes of the central and peripheral human corneal nerves by exvivo laser-scanning confocal microscopy (EVCM).

Methods 24 eyes from 14 cadavers were retrieved at different time intervals after death and examined by EVCM. Five regions were examined in each eye: central, superior, inferior, temporal and nasal. In each region, corneal nerve images were categorised according to their anatomical location in the cornea into sub-basal, stromal and limbal nerves. Five nerve parameters were measured: density, orientation, diameter, numbers and branching pattern.

Results Exvivo confocal scanning of a motionless eye allows high quality imaging and tracking of corneal and limbal nerves. Stromal nerves from the sub-Bowman's plexus perforate the Bowman's zone and terminate in bulb-like structures, from each of which a leash of sub-basal nerves arises. Following death, sub-basal nerve parameters showed significant changes. The density decreased from 9.23±4.48 to 0.45±0.07 mm/mm2, the diameter from 4.01±0.81 to 2.08±0.20 μm, the numbers from 8.3 to 1.0 and branching pattern from 39.38% to 0% (p<0.05) from day 1 to day 5 postmortem. Stromal and limbal nerves showed no significant changes in their density and diameter.

Conclusions This study establishes a direct link between sub-basal nerves and the sub-Bowman's nerves via distinct terminal bulbs. Limbal nerves are the thickest, are seen in all quadrants and can be traced to the corneal centre. The sub-basal nerve plexus rapidly degenerates after death but stromal and limbal nerves survive during the first five days after death.

  • Ex-vivo confocal microscopy
  • corneal nerves
  • limbal nerves
  • cornea
  • anatomy
  • imaging

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  • Funding MAA is funded for his studentship by the Ministry of Higher Education, Government of Iraq.

  • Competing interest None.

  • Ethics approval This study was conducted with the approval of the Nottingham ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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