The Application of in vivo laser scanning confocal microscopy as a tool of conjunctival in vivo cytology in the diagnosis of dry eye ocular surface disease

摘要

Purpose: To evaluate the applicabilityof in vivo laser scanning confocal microscopy as a tool of conjunctivalcytology in a prospective case-control study. Methods: Nineteen right eyes of 19Sjogren’s syndrome dry eye patients (19 females; mean age: 55.8±15years), and 18 right eyes of 18 normal healthy control subjects (12females and 6 males; mean age: 50.8±14 years) were evaluated in thisstudy. The eyes were analyzed by the Heidelberg retina tomography(HRTII)/Rostock cornea module (RCM). Ocular surface and tear functiontests including vital stainings (fluorescein and Rose Bengal), Schirmertest, tear film break up time (BUT), and conjunctival impressioncytology were performed. After obtaining the confocal microscopyimages, the mean individual epithelial cell area (MIECA), andnucleocytoplasmic (N/C) ratio were analyzed. The correlation betweenconfocal microscopy and impression cytology parameters was alsoinvestigated. Results: The BUT, Schirmer test values,vital staining scores and squamous metaplasia grades in impressioncytology were significantly worse in dry eye patients compared tocontrols (p0.0001). The MIECA and the mean N/C ratios were worse indry eye subjects compared to controls both in impression cytology andin vivo confocal microscopy (p0.0001) with no significantdifferences between these parameters when the two examinationtechniques were compared. The MIECA and N/C ratio in conjunctivalimpression cytology showed significant correlation with thecorresponding confocal microscopy parameters (MIECA, r2:0.557; N/C, r2:0.765). Conclusions: Laser scanning confocalmicroscopy seems to be an efficient non-invasive tool in the evaluationof phenotypic alterations of the conjunctival epithelium in dry eyedisease. N/C ratio and MIECA appear to be two promising and newparameters of in vivo confocal cytology in the assessment of the ocularsurface in dry eye disease.