Laser confocal microscopy is a valuable, non-invasive tool for early diagnosis and characterisation of epithelial nests

A 22-year-old woman presented with blurred vision and glare in the right eye, which had been present for three months. The patient had undergone laser-assisted in situ keratomileusis nine months previously and enhancement three months thereafter. On ophthalmological examination, visual acuity was 6/8.6 in the right eye and 6/6 in the left eye. An opaque epithelial nest below the flap with a visible demarcation line was detected along the pupil margin in the right eye. Subsequent laser confocal microscopy revealed the presence of epithelial cells in a whorled pattern with irregular astigmatism on corneal topography. Three months later, the clinical symptoms had worsened and a denser and larger wedge-shaped epithelial nest was observed. The nest was scraped. Six months later, the patient exhibited restored visual acuity (6/6) without glare. Laser confocal microscopy is a valuable, non-invasive tool and provides in vivo pathological images for early diagnosis and localisation of lesion depth in epithelial nests to guide appropriate surgical management.