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L. Gheck, V. Iordanidou, F. Brignole-Baudouin, C. Baudouin; Evaluation of Pterygium Activity Using in vivo Confocal Microscopy : An Immuno-Histochemical Study. Invest. Ophthalmol. Vis. Sci. 2008;49(13):6036. doi: https://doi.org/.
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The purpose of this study was to correlate the clinical and histopathological appearance of pterygium with the images obtained by the in vivo confocal microscopy. Moreover, impression cytology of the pterygium and of the adjacent conjunctiva were analyzed.
Forty one pterygia of 21 patients without history of past ocular surgery, were included in the study. A clinical activity score for each pterygium was assessed and included the biomicroscopic aspect as well as the patient’s discomfort. Moreover, examination by the in vivo confocal microscope Heidelberg retina tomography (HRT II)/Rostock Cornea Module was performed. Impression cytology from the pterygium was obtained, and the density of goblet and dendritic cells was evaluated. Finally, impression cytology was performed on the adjacent bulbar conjunctiva and HLA DR antigen expression by flow cytometry was quantified. All the above analyzed parameters were correlated between them.
The in vivo confocal microscopy allowed a precise analysis of the pterygium activity. A positive correlation was found between the goblet cell density and both the clinical activity score and the dendritic cell density (correlation coefficient of Pearson of 0.773 and 0.966 respectively).HLADR antigen was expressed at high rates whatever the clinical activity score of the pterygium was.
In vivo confocal microscopy is a useful tool for the analysis of pterygium, and is helpful in differentiating between active and inactive pterygium. The goblet cell density at the pterygium surface is correlated to the pterygium activity, and is probably stimulated more by local inflammation than by mechanical factors. The fact that inflammation plays a key role in pterygium pathogenesis is supported by the high HLA DR expression of adjacent conjunctiva.
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