Diagnosing and Monitoring Corneo-Conjunctival Ocular Surface Squamous Tumors: An in vivo Confocal Microscopy Approach

Abstract

Purpose: : To analyze Ocular Surface Squamous (OSS) tumors using clinical confocal microscopy and compare the in-vivo imaging with cytological aspect before and after treatment.

Methods: : Ten consecutive cases of OSS tumors were investigated at baseline and during follow-up using in-vivo clinical corneal and conjunctival confocal microscopy (Confoscan 4, Nidek). All tumors underwent topical chemotherapy with 1% 5-FU four times daily for 4 weeks (one course). Baseline and follow-up data obtained with confocal microscopy were compared to cytologic samples obtained by scraping technique. Follow-up was longer than 12 months.

Results: : Mean follow-up was 18±3 months. Baseline confocal microscopy analysis of OSS tumors showed good agreement with correspondent cytologic tumor aspect and reveals some structural-histologic characteristics of the lesions. All patients showed clinical regression of OSS tumor after one course of topical 1% 5-FU treatment. Confocal microscopy analysis showed complete replacement of OSS neoplastic cell by normal epithelium within 4 months in 8 cases. Two cases showed persistent structural and corneo-conjunctival cytological abnormalities consistent with a suspect early recurrence or with just partial eradication of the lesion. These two patients underwent additional course of topical chemotherapy with complete clinically and confocal imaging eradication.

Conclusions: : In-vivo corneal and conjunctival confocal microscopy is a reliable non-invasive method to follow clinical and cyto-histologic aspect of OSS tumors, particularly when treated with topical chemotherapy.

Keywords: tumors • conjunctiva • imaging/image analysis: clinical