Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study

Abstract

Purpose: Investigating impression cytology (IC) results of various types of clinically suspected ocular surface lesions over a 14-year period in a referral center in Iran. Methods: IC findings obtained from patients with different types of ocular surface disorders between 2005 and 2018 were reviewed. Agreement between clinical suspicions and IC results was evaluated by calculating Cohen’s Kappa coefficient (CKC). Results: Clinical suspicions in 688 surveyed eyes were ocular surface squamous neoplasia (OSSN, 42.0%), limbal stem cell deficiency (LSCD, 36.3%), dry eye-related disorders (DERD, 11.5%), Acanthamoeba keratitis (AK, 7.2%), benign pigmented lesions (BPL, 1.9%), immune-related conjunctivitis (IRC, 0.7%), and malignant pigmented lesions (MPL, 0.4%). General agreement between clinical suspicions and IC results was 0.68 for all groups. This agreement was almost perfect in AK (CKC = 0.966) and BPLs (CKC = 0.843), and was substantial in MPLs (CKC = 0.749), OSSNs (CKC = 0.684), and LSCD (CKC = 0.612). CKC in IRC (0.567) and DERDs (0.443) was moderate. Histopathologic results were available in 22 eyes and were well-correlated with corresponding IC results (CKC = 0.86). Multiple post-treatment follow-up sessions of IC were performed in 51 eyes (11.4%) that had diagnosis of LSCD (31), OSSN (17), and MPL (3) at the first IC session. Conclusion: Our survey not only demonstrated an overall substantial agreement between IC results and primary clinical suspicions, but also showed an almost perfect correlation between IC results and existent histopathologic data. Therefore, IC as a non-invasive diagnostic modality can be of great importance in proper diagnosis of various ocular surface diseases especially when distinguishing malignant from benign lesions is required.

Cytological and microbiological evaluation of conjunctiva in camels with and without conjunctivitis

“…10 The presence of neutrophils, however, may be linked to different etiology, including conjunctival sterile inflammation, bacterial or viral infections, allergic disease, or occasionally other causes. 8,9 The conjunctival epithelial cells consisted mainly of superficial cells, which is in agreement with findings in the dog reported, 24 but in contrast to the cytological composition in buffalos, where intermediate and basal cells dominated other types of epithelial cells. 25 The presence of melanin pigment in epithelial cells from normal animals in the present study could be associated with the animal coat color.…”

“…Similarly, the significantly higher percentage of neutrophils in the ocular cytology of affected camels was in agreement with previous studies in other species. [8][9][10]19,29 Although 13 stated that neutrophilic conjunctival inflammation in dogs may be caused by bacterial or viral infections, allergic disease, or occasionally other causes. The presence of degenerative and non-degenerative in the study indicates acute infections of bacterial origin.…”

“…Conjunctival cytology provides a valuable tool for the assessment of the cellular reaction within the epithelium and the identification of foreign bodies and microorganisms, which supports the understanding of pathogenesis and prognosis of many ocular diseases. [6][7][8][9][10][11] Cytologic findings of the eyes have been reported in the veterinary literature mainly for the equine, bovine, canine, and feline species. 12 Cytologic specimens are usually examined for the presence of inflammatory cells, infectious agents, intracellular inclusion bodies, and neoplastic cells.…”

“…The conjunctiva is variably pigmented. Conjunctival cytology provides a valuable tool for the assessment of the cellular reaction within the epithelium and the identification of foreign bodies and microorganisms, which supports the understanding of pathogenesis and prognosis of many ocular diseases 6–11 . Cytologic findings of the eyes have been reported in the veterinary literature mainly for the equine, bovine, canine, and feline species 12 .…”

Real-world experience of using ciclosporin-A 0.1% in the management of ocular surface inflammatory diseases

“…A symptom, reflecting the subjective sensation experienced by the patient and a diagnosis by virtue of the label assigned to the condition based on clinical signs, such as narrow tear meniscus, rapid tear film break-up time and punctate OS erosions; with or without the support of tests ranging from the Schirmer's test to in vivo confocal microscopy of the corneal epithelium and impression cytology of the OS. [19][20][21] The nomenclature is varied with 'DED' being the most popular but terms such as keratoconjunctivitis sicca, xerosis ophthalmia and others are also used with the same connotation. Arguably DED is not one condition but a common downstream manifestation of a host of local or systemic diagnoses.…”