Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China.
Eye (Lond). 2012 Jun;26(6):781-7. doi: 10.1038/eye.2012.15. Epub 2012 Mar 9.
To determine the reliability and efficiency of in vivo confocal microscopy for the diagnosis of ocular surface squamous neoplasia (OSSN).
A case series with five consecutive cases of OSSN were investigated retrospectively, of which the characteristics and subspecial types had been estimated by in vivo confocal microscopy before surgery. The structure and cellular features of OSSN were analyzed with other examinations, such as anterior-segment optical coherence tomography (AS-OCT), and confirmed by histopathological biopsy.
The tumors revealed red gelatinous surfaces with vascular dilatation on the ocular surface of the conjunctival and corneal epithelium in anterior segment photography. Involvement of only corneal epithelium was observed by AS-OCT in three cases, whereas the Bowman's layer and anterior stroma were also invaded in the other two cases. In vivo confocal microscopy showed cellular anisocytosis and enlarged nuclei with high nuclear to cytoplasmic ratio in three cases diagnosed as conjunctival intraepithelial neoplasia; moreover, nests were partially formed by isolated keratinized, binucleated, and actively mitotic dysmorphic epithelial cells in the other two cases diagnosed as carcinoma in situ and ocular surface squamous carcinoma (OSSC). The characteristics assessed from histopathological biopsy were similar to that revealed by in vivo confocal microscopy in all five cases.
In vivo confocal microscopy analysis of cytological characteristics of OSSN is a safe, relatively noninvasive, and effective diagnostic tool in detecting characteristics of OSSN before surgical resection. Although in vivo confocal microscopy cannot replace excisional biopsy for definitive diagnosis, it can be valuable for initial diagnosis and management of patients with OSSN.
确定活体共聚焦显微镜用于诊断眼表鳞状细胞癌（OSSN）的可靠性和效率。
回顾性研究了 5 例连续的 OSSN 病例，这些病例在手术前通过活体共聚焦显微镜评估了其特征和亚专科类型。使用其他检查（如眼前节光学相干断层扫描（AS-OCT））分析 OSSN 的结构和细胞特征，并通过组织病理学活检证实。
在前节摄影中，肿瘤在结膜和角膜上皮的眼表面呈现出红色胶状表面，伴有血管扩张。在 3 例中，AS-OCT 仅观察到角膜上皮受累，而在另外 2 例中，Bowman 层和前基质也受到侵犯。活体共聚焦显微镜显示 3 例诊断为结膜上皮内瘤变的病例中存在细胞异型性和细胞核增大，核质比高；另外 2 例诊断为原位癌和眼表鳞状细胞癌（OSSC）的病例中，部分形成了孤立的角化、双核和活跃有丝分裂的异型上皮细胞巢。所有 5 例病例的组织病理学活检特征与活体共聚焦显微镜评估的特征相似。
在活体内对 OSSN 的细胞学特征进行共聚焦显微镜分析是一种安全、相对无创且有效的诊断工具，可在手术切除前检测 OSSN 的特征。尽管活体共聚焦显微镜不能替代切除活检作为明确诊断，但它对 OSSN 患者的初步诊断和管理具有重要价值。
