Abstract
Abstract: :
Purpose: The Rostock Cornea Modul (RCM)/Heidelberg Retinograph (HRTII) system operates with a 670 nm diode laser and therefore allows visualization of conjunctival structures in a resolution up to 1 µm. Methods: Confocal microscopy was performed in 59 eyes with conjunctival lesions using the RCM/HRTII. Conjunctival disease analyzed included benign lesions (9 pterygia, 9 pingueculae, 1 papilloma, 1 dermoid, 1 lymphangioma, 6 nevi, 11 primary acquired melanoses–PAM, 3 secondary acquired melanoses) as well as malignant tumors (6 melanoma, 2 carcinoma in situ–CIN, 3 lymphoma). Between 61 and 551 images (ø 203 images) were obtained of each eye. In 24 of these patients histological sections of the same lesion were compared with confocal in vivo microscopy. Results: Pterygia and pingueculae demonstrated typical histological features such as increased vascularization, derangement of collagen fibers, calcium deposits and rare inflammatory cells. The papilloma showed multiple fronds of proliferated epithelium surrounding fibrovascular cores. Pigmented lesions could be differentiated by their typical in vivo microscopic features: Nevi showed highly reflective nevus cell nests and pseudocyst formation. PAM was characterized by highly reflective dendritic cells, single large atypical cells with prominent nucleoli and clumps of pigment in the conjunctival epithelium as well as pigment dispersion into the corneal epithelium. Melanoma exhibited multiple large, partly highly reflective cells with unusually prominent nucleoli and large tumor vessels. CIN lesions were acanthotic with highly reflective keratinized superficial cells, atpyical epithelial cells and intraepithelial dendritic cells. Lymphoma could not be visualized due to its subconjunctival localization. Histology highly correlated with the images obtained by in vivo confocal microscopy. Conclusions: In vivo confocal microscopy using the RCM/HRTII allows direct imaging of conjunctival lesions and is able to differentiate between benign and malignant conjunctival tumors.
Keywords: conjunctiva • imaging/image analysis: clinical • tumors