Ramirez-Miranda Arturo, Guerrero-Becerril Jesus, Ramirez Manuel, Vera-Duarte Guillermo Raul, Mangwani-Mordani Simran, Ortiz-Morales Gustavo, Navas Alejandro, Graue-Hernandez Enrique O, Alio Jorge L
Departamento de Córnea y Cirugía Refractiva, Instituto de Oftalmología Fundación Conde de Valenciana IAP, Mexico City, Mexico.
Departamento de Córnea y Cirugía Refractiva, Asociación para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Clin Ophthalmol. 2025 Jun 7;19:1817-1834. doi: 10.2147/OPTH.S519705. eCollection 2025.
In vivo confocal microscopy (IVCM) is an advanced imaging technique that enables real-time, high-resolution visualization of corneal microstructures. Its clinical applications have expanded significantly, offering valuable insights into the pathophysiology of various ocular surface and corneal disorders. Despite its utility, challenges in standardization, accessibility, and integration into routine practice limit its widespread adoption.
A comprehensive literature review was conducted using PubMed with the keywords "in vivo confocal microscopy", "corneal diseases", and "ocular surface". From 1835 articles retrieved, studies published within the last seven years with clinical relevance were prioritized, yielding 51 articles. Data were synthesized to evaluate IVCM's diagnostic capabilities, technical advancements, and applications across corneal pathologies, including infectious keratitis, dystrophies, and post-surgical outcomes.
IVCM was shown to provide unparalleled visualization of cellular and subcellular corneal structures, enabling early diagnosis and monitoring of conditions such as keratitis caused by Acanthamoeba and fungi, corneal dystrophies, and nerve regeneration following refractive or transplant surgeries. Innovative applications include its use in regenerative therapies, such as adipose-derived stem cell implantation, demonstrating increases in keratocyte density and stromal integrity. However, limitations include operator dependency, high costs, and the need for further technological refinements, such as wide-field imaging and non-contact modalities.
IVCM represents a transformative tool in ophthalmology, bridging the gap between clinical evaluation and cellular-level diagnostics. Advances in imaging technologies and the integration of artificial intelligence hold the potential to overcome current limitations, enhancing its diagnostic precision and applicability. Standardization of protocols and expanded access will be pivotal in establishing IVCM as a cornerstone in the management of corneal diseases and ocular surface disorders.
体内共焦显微镜检查（IVCM）是一种先进的成像技术，能够实时、高分辨率地显示角膜微观结构。其临床应用已显著扩展，为各种眼表和角膜疾病的病理生理学提供了有价值的见解。尽管其具有实用性，但在标准化、可及性以及融入常规实践方面存在的挑战限制了其广泛应用。
使用PubMed进行了全面的文献综述，关键词为“体内共焦显微镜检查”“角膜疾病”和“眼表”。从检索到的1835篇文章中，优先选取过去七年发表的具有临床相关性的研究，得到51篇文章。对数据进行综合分析，以评估IVCM在角膜病变（包括感染性角膜炎、营养不良和手术后结果）方面的诊断能力、技术进展和应用。
IVCM能够提供无与伦比的角膜细胞和亚细胞结构可视化，有助于早期诊断和监测棘阿米巴和真菌引起的角膜炎、角膜营养不良以及屈光或移植手术后的神经再生等情况。创新应用包括其在再生治疗中的应用，如脂肪来源干细胞植入，显示角膜细胞密度和基质完整性增加。然而，局限性包括对操作人员的依赖性、高成本以及对进一步技术改进的需求，如宽视野成像和非接触模式。
IVCM是眼科领域的一种变革性工具，弥合了临床评估与细胞水平诊断之间的差距。成像技术的进步和人工智能的整合有望克服当前的局限性，提高其诊断精度和适用性。方案的标准化和扩大可及性对于将IVCM确立为角膜疾病和眼表疾病管理的基石至关重要。
