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C. M. Gentile, J. O. Croxatto; In vivo Diagnosis of Epithelial Neoplastic Changes of the Cornea and Conjunctival Limbus Using Confocal Microscopy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5680.
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The aim of this study was to analyze the morphological features of limbal and cornea intraepithelial neoplasia using in vivo confocal corneal microscopy.
Seven eyes of 4 females and 3 males (age range from 56 to 76 years-old) with presumed diagnosis of conjunctival and cornea intraepithelial neoplasia (CIN) were included. In addition, images from patients with disorders of the ocular surface including leukoplakic lesions associated with pterygium, corneal epithelium regeneration, and dry eye were used for comparative purposes. Clinical examination included slit-lamp biomicroscopy with rose bengal stain, and in vivo confocal corneal microscopy (Rostock Corneal Module, Heidelberg, Germany). Recorded images were analyzed and compared with clinical features, and histological findings after surgery.
Confocal microscopic images of CIN revealed pleomorphic, medium-sized hyperreflective nucleated cells with indistinct cytoplasmic bordes throughout the thickness of the epithelium with a sharp transition between neoplastic and non-neoplastic epithelium. Reactive and proliferative non-neoplastic conditions showed large epithelial cells with reinforcement of cell membrane, islands of abnormal cells at the margins, and cellular descamation. Although all but one case were restricted to the epithelium, confocal microscopy provided information regarding the level of corneal invasion. In one patient who had history of radial keratotomy and LASIK surgery, confocal microscopy was useful to evaluate the involvement along the incisions of previous refractive surgery.
In vivo confocal corneal microscopy is a non invasive clinical technique which may be used in the cellular diagnosis of epithelial neoplasia and a useful tool for the differential diagnosis between CIN and benign epithelial proliferations and degenerations; being valuable for therapeutic decisions and early identification of recurrence.
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