In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET

Abstract

Examination of the corneal surface by in vivo confocal microscopy (IVCM) allows for objective identification of corneal and conjunctival cell phenotypes to evaluate different epithelialization patterns. Detection of a corneal-conjunctival epithelial transition could be considered as a sign of restored epithelial function following simple limbal epithelial transplantation (SLET). This is a prospective, interventional case series. We assessed patients with limbal stem cell deficiency (LSCD) by IVCM, preoperatively and at monthly intervals following SLET. Sectors in the central and peripheral cornea were scanned. Immediately upon detection of multi-layered cells with the epithelial phenotype in the central cornea and confirmation of epithelial transition in all corneal sectors, the decision for keratoplasty was taken. Ten patients were enrolled. After SLET, epithelial phenotype in the central cornea and an epithelial transition were identified within six and nine months in seven and one patients, respectively. One patient was a partial success and one failed. Five patients underwent keratoplasty, with stable results up to 12 months. Identification of the epithelial transition zone by IVCM permits assessment of the efficacy of SLET, enabling subsequent planning of keratoplasty for visual rehabilitation. The stability of the corneal surface following keratoplasty confirms that the renewal of the corneal epithelium was effectively retained.

Microscopic corneal epithelial changes and clinical outcomes in simple limbal epithelial transplantation surgery after treatment with amniotic membrane eye drops (AMED): A case report

“…Also, while no transition zone between the corneal and conjunctival epithelium was noted in 2 out of 4 quadrants (i.e., inferior-nasal and inferior-temporal), 6 the sub-basal nerve plexus showed a reduced corneal nerve density in all the analyzed sectors.…”

“… 12 Also, due to their ability at inducing limbal stem cell (LSC) migration, inhibiting cellular apoptosis, and at maintaining epithelial progenitor cells within the LSC niche, recent studies have identified h-AMs as useful scaffolds to be applied to the field of corneal tissue engineering. 6 , 13 , 14 , 15 …”

“…1 ). On in vivo confocal microscopy (IVCM-HRT3 RCM, Heidelberg Engineering GmbH), the corneal surface showed areas of inflammation with Langerhans cells and leucocytes, and conjunctival epithelium-like features (i.e., cuboidal or polygonal cells of increased dimensions, visible nuclei, loss of cellular borders, higher cytoplasmic reflectivity compared to the normal corneal epithelium, presence of goblet cells) 5 , 6 over approximately 50% of the whole surface ( Fig. 1 ).…”

Detection of Meibomian Gland Dysfunction by in vivo Confocal Microscopy Based on Deep Convolutional Neural Network

“…The laser focusing principle of IVCM is used to scan each point of the detected layer in the confocal plane. In IVCM, the formation of ocular surface tissues can be observed at multiple levels, and the cell level of tissue morphology and changes can be photographed in real time 4 . Hence, IVCM has real-time, non-invasive, three-dimensional advantages.…”