In vivo confocal microscopy of ocular surface squamous neoplasia

Abstract

Purpose To analyse in vivo structural and cellular features of ocular surface squamous neoplasia using clinical confocal microscopy. Methods Ten consecutive cases of untreated ocular surface squamous neoplasia were in vivo investigated using clinical confocal microscopy (ConfoScan4, Nidek Co. Ltd, Gamagori, Japan) with a  40 surface non-contact objective lens. Confocal microscopy images were compared with cytologic samples obtained by scraping technique. Results Confocal microscopy examination revealed large areas of superficial cells debris and/or keratin debris accompanied by syncytial-like groupings, loss of the normal structure of the conjunctival epithelium and\or of the corneal basal epithelium layer, papillomatous organization, large fibrovascular structures, and fine vessels perpendicular to the tumour surface. Sub-epithelial (pre-Bowman) space involvement was documented in four cases (50%). Irregular healthy tissue infiltration at the lateral edge of the lesion was documented in two cases (20%) whereas abrupt demarcation between neoplastic cells and normal epithelium was documented in eight cases (80%). In vivo cyto-morphologic study using clinical confocal microscopy showed cellular anisocytosis, pleocytosis, and anisonucleosis, enlarged nuclei with high nuclear to cytoplasmic ratio, high reflective cytoplasm and indistinct cytoplasmic borders in all cases (100%). Conclusion CCM appears to be a promising and non-invasive method for in vivo structural and cellular analysis of OSSN.

The clinical value of in vivo confocal microscopy for diagnosis of ocular surface squamous neoplasia

“…These findings were also supported by other studies comparing the images from in vivo confocal microscopy with cytological samples obtained by either scraping or histopathological biopsy. 20,21 Recent studies suggest that the accuracy of diagnosis with cytological in vivo confocal microscopy could be improved by the implementation of automated image analysis. This technique has been widely used in the interpretation of conjunctival and corneal exfoliative cytological analysis, and the acquired characteristics of cells were similar to those obtained from biopsies of OSSN.…”

Anterior Segment Applications of In Vivo Confocal Microscopy

“…IVCM has been recently investigated in order to check its reliability and efficiency for diagnosis of ocular surface squamous neoplasia. 94,95 Chin et al reported a case of biopsy-proven corneal intra epithelial neoplasia (CIN) diagnosed and followed using anterior segment OCT and IVCM. In this case, slit lamp examination postoperatively revealed barely visible residual disease, whereas IVCM demonstrated dysplastic cells consistent with residual disease.…”

Impression cytology in the evaluation of ocular surface tumors: review article

“…Due to the multifocal nature of OSSN, surgical excision results in extensive collateral damage to adjacent areas of normal epithelium (37) . In addition to IC, newer diagnostic techniques including CCM (22) , toluidine blue (38) , and ultra-high resolution anterior segment optical coherence tomography (UHR-OCT) (39) have been reported to aid in the diagnosis of OSSN. All these techniques have limitations and require skilled professionals to perform the tests and interpret the results.…”

“…The introduction of in vivo stains or biomarkers to better visualize these cellular details would be useful to improve image quality and to obtain more detailed information. A novel CCM specific index score to differentiate SCC from preinvasive ocular surface lesions is still necessary (22) . IC may be less sensitive for cases with keratotic lesions because an abundance of surface keratin can make sampling inaccurate (5) .…”