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T. Kojima, Y. Matsumoto, O. Ibrahim, E. Sato, M. Dogru, K. Tsubota; In vivo Observation of Superior Limbic Keratoconjunctivitis Using Laser Scanning Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):518.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate and characterize the findings of superior limbic keratoconjunctivitis (SLK) using laser scanning confocal microscopy
Fifteen eyes of 8 patients (5 females, 3 males; mean age:49±17 years) with SLK were analyzed by the Heidelberg retina tomography (HRTII)/Rostock cornea module (RCM). Ocular surface and tear function tests including vital stainings (fluoresccein and Rose Bengal), Schirmer test, tear clearance test and conjunctival impression cytology were performed. After obtaining the confocal images, the mean individual epithelial cell area (MIECA) and nucleocytoplasmic (N:C) ratio were analyzed using the Image J software. The severity of SLK was graded according to these new confocal microscopy and were compared with Nelson’s impression cytology squamous metaplasia grading criteria.
The MIECA was 738± 456µm2 (290 ~ 1842µm2). The mean N:C ratio was 0.37± 0.10 (0.22 ~ 0.52). These values fared worse than the values reported in healthy control subjects. The grades of squamous metaplasia in conjunctival impression cytology showed correlation with the confocal microscopy parameters of squamous metaplasia. The confocal microscopy grades of squamous metaplasia significantly correlated with Rose-Bengal staining scores of the superior bulbar conjunctiva. The basal conjunctival epithelial cell layer was relatively healthy. with the limbal area revealing marked infiltration of inflammatory cells including polymorphs and dendritic cells. Confocal microscopy showed improvement of conjunctival squamous metaplasia and decrease of inflammatory cells with treatment.
Laser scanning confocal microscopy seems to be an efficient non-invasive tool in the evaluation of phenotypic alterations of the conjunctival epithelium in SLK and the treatment responses. MIECA and N:C ratio appear to be two promising and new parameters of in vivo confocal microscopy in the assessment of the ocular surface disease in SLK.
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