Division of Ophthalmology and Visual Sciences, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom.
Am J Ophthalmol. 2011 Feb;151(2):238-47. doi: 10.1016/j.ajo.2010.08.035. Epub 2010 Dec 18.
To ascertain in vivo confocal microscopic features of corneal/conjunctival intraepithelial neoplasia (CIN) and correlate these with histology of the same lesions.
Observational case series with evaluation of diagnostic technology.
Four patients with unilateral CIN (3 men and 1 woman) were examined with the Heidelberg Retina Tomograph II (HRT II) Rostock Cornea Module (RCM) confocal microscope before, during, and after treatment. Corneal epithelial samples were taken by alcohol delamination technique in 2 patients, while impression cytology (IC) samples were obtained in the other 2 patients. Morphometric analysis of confocal and histologic images was carried out and the findings correlated. Four controls (all men, 2 with limbal stem cell deficiency, 1 with a limbal lesion, and 1 with diffuse keratoconjunctival proliferation) were similarly examined. Two of these had biopsy for histologic examination. Main outcome measures comprised the degree of correlation between histology and confocal microscopic features of CIN.
Dysplastic cellular changes were noticed on histopathology and correlated well with confocal microscopy, corresponding to the different corneal epithelial layers. Bright nucleoli within huge nuclei and ill-defined cell borders were a feature of the basal epithelium on histopathology and confocal microscopy. Subbasal corneal nerves were not visualized on confocal microscopy in areas affected by CIN. These features disappeared in response to treatment cycles as the basal epithelium reverted to its normal pattern, as seen by confocal microscopy.
Confocal microscopy findings highly correlate with histologic features in CIN. Confocal microscopic features of CIN as defined in this study will enable a reliable diagnosis in a noninvasive manner. Confocal microscopy will also allow real-time monitoring of the condition during treatment.
确定角膜/结膜上皮内瘤变（CIN）的活体共聚焦显微镜特征，并将这些特征与同一病变的组织病理学进行相关分析。
具有诊断技术评估的观察性病例系列。
对 4 名单侧 CIN 患者（3 名男性和 1 名女性）进行检查，使用海德堡视网膜断层扫描仪 II（HRT II）Rostock 角膜模块（RCM）共聚焦显微镜在治疗前、治疗期间和治疗后进行检查。在 2 名患者中通过酒精分层技术获取角膜上皮样本，而在另外 2 名患者中获得印迹细胞学（IC）样本。对共聚焦和组织学图像进行形态计量分析，并对结果进行相关分析。另外还对 4 名对照者（均为男性，2 名患有角膜缘干细胞缺乏症，1 名患有角膜缘病变，1 名患有弥漫性角结膜增殖）进行了类似检查。其中 2 名进行了活检以进行组织病理学检查。主要观察指标包括组织病理学和 CIN 的共聚焦显微镜特征之间的相关性程度。
组织病理学检查发现了发育不良的细胞变化，与共聚焦显微镜检查结果密切相关，这些变化与角膜上皮的不同层相对应。组织病理学和共聚焦显微镜上的基底上皮均可见大核内的亮核仁及边界不清晰的细胞。受 CIN 影响的区域的角膜神经亚基底无法在共聚焦显微镜下显示。这些特征在接受治疗后随着基底上皮恢复正常模式而消失，这在共聚焦显微镜下可见。
共聚焦显微镜检查结果与 CIN 的组织学特征高度相关。本研究中定义的 CIN 的共聚焦显微镜特征将以非侵入性的方式实现可靠的诊断。共聚焦显微镜还可以在治疗过程中实时监测病情。
