Klin Monbl Augenheilkd 2012; 229(7): 696-704
DOI: 10.1055/s-0032-1314986
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Konfokale In-vivo-Mikroskopie – Korrelation zu histologischen Befunden

In Vivo Confocal Microscopy – Correlation to Histology
E. M. Messmer
1   Augenklinik der Ludwig-Maximilians-Universität, Universitäts-Augenklinik, München
› Author Affiliations
Further Information

Publication History

eingereicht 01 March 2012

akzeptiert 02 May 2012

Publication Date:
25 July 2012 (online)

Zusammenfassung

Die konfokale In-vivo-Mikroskopie bietet die faszinierende Möglichkeit, schnell und nicht invasiv histologisch-zytologische Schnittbilder der Augenoberfläche zu gewinnen und Langzeitverläufe zu beobachten. Sie erleichtert die Einordnung unklarer Hornhautbefunde, kann wichtige differenzialdiagnostische Hinweise in der Abklärung von Bindehauterkrankungen geben und hat unser Wissen über Erkrankungen des Lidrands erweitert. Zur richtigen Interpretation von konfokalmikroskopischen Scans sind profunde Kenntnisse der mikroskopischen Anatomie und Histopathologie notwendig. Um die Inter-Untersucher-Variabilität zu reduzieren und einen Vergleich wissenschaftlicher Arbeiten zu erlauben, müssen konfokalmikroskopisch-histologische Korrelationen erarbeitet und Standards für die Interpretation in vivo konfokalmikrokoskopischer Befunde erstellt werden. Bei unklarer Dignität einer Läsion der Augenoberfläche ist nach wie vor die exzisionale Biopsie mit histopathologischer Untersuchung Goldstandard.

Abstract

In vivo confocal microcopy is a fascinating technique to obtain rapidly and non-invasively histological/cytological sections of the ocular surface, and observe long-term changes. It allows classification of corneal findings, facilitates the diagnosis of conjunctival lesions, and has broadened our understanding of lid margin disease. To correctly interpret in vivo confocal scans, profound knowledge of microscopic anatomy and histopathology are crucial. To reduce inter-observer variability and allow comparison of scientific studies, in vivo confocal-histopathological correlations have to be investigated, and standards for the interpretation of in vivo confocal microscopic findings must be established. In suspicious lesions of the ocular surface an excisional biopsy and histopathological examination are still the gold standard.

 
  • Literatur

  • 1 Minsky M. Memoir on inventing the confocal microscope. J Scanning 1988; 10: 128-138
  • 2 Just T, Zeisner C, Stave J et al. Confocal laser-scanning microscopy to analyse the epithelium of the tongue. Laryngorhinootologie 2004; 83: 108-112
  • 3 Messmer EM, Torres SE, Mackert MI et al. In vivo confocal microscopy in blepharitis. Klin Monatsbl Augenheilkd 2005; 222: 894-900
  • 4 Messmer EM, Mackert MJ, Zapp DM et al. In vivo confocal microscopy of normal conjunctiva and conjunctivitis. Cornea 2006; 25: 781-788
  • 5 Messmer EM, Mackert MJ, Zapp DM et al. In vivo confocal microscopy of pigmented conjunctival tumors. Graefes Arch Clin Exp Ophthalmol 2006; 244: 1437-1445
  • 6 Stave J, Zinser G, Grummer G et al. Modified Heidelberg Retinal Tomograph HRT. Initial results of in vivo presentation of corneal structures. Ophthalmologe 2002; 99: 276-280
  • 7 Cavanagh HD, Jester JV, Essepian J et al. Confocal microscopy of the living eye. CLAO 1990; 16: 65-73
  • 8 Dilly P. Tandem scanning reflected light microscopy of the cornea. Scanning 1988; 10: 153-156
  • 9 Lemp MA, Dilly PN, Boyde A. Tandem-scanning (confocal) microscopy of the full-thickness cornea. Cornea 1985; 4: 205-209
  • 10 Masters BR. Scanning slit confocal microscopy of the in vivo cornea. Opt Eng 1995; 34: 684-692
  • 11 Niederer RL, McGhee CN. Clinical in vivo confocal microscopy of the human cornea in health and disease. Prog Retin Eye Res 2010; 29: 30-58
  • 12 Alomar T, Matthew M, Donald F et al. In vivo confocal microscopy in the diagnosis and management of acanthamoeba keratitis showing new cystic forms. Clin Experiment Ophthalmol 2009; 37: 737-739
  • 13 Alomar TS, Al-Aqaba M, Gray T et al. Histological and confocal microscopy changes in chronic corneal edema: implications for endothelial transplantation. Invest Ophthalmol Vis Sci 2011; 52: 8193-8207
  • 14 Kanavi MR, Javadi M, Yazdani S et al. Sensitivity and specificity of confocal scan in the diagnosis of infectious keratitis. Cornea 2007; 26: 782-786
  • 15 Kobayashi A, Sugiyama K. In vivo laser confocal microscopy findings for Bowmanʼs layer dystrophies (Thiel-Behnke and Reis-Bucklers corneal dystrophies). Ophthalmology 2007; 114: 69-75
  • 16 Kobayashi A, Fujiki K, Fujimaki T et al. In vivo laser confocal microscopic findings of corneal stromal dystrophies. Arch Ophthalmol 2007; 125: 1168-1173
  • 17 Shiraishi A, Uno T, Oka N et al. In vivo and in vitro laser confocal microscopy to diagnose acanthamoeba keratitis. Cornea 2010; 29: 861-865
  • 18 Winchester K, Mathers WD, Sutphin JE et al. Diagnosis of Acanthamoeba keratitis in vivo with confocal microscopy. Cornea 1995; 14: 10-17
  • 19 Winchester K, Mathers WD, Sutphin JE. Diagnosis of Aspergillus keratitis in vivo with confocal microscopy. Cornea 1997; 16: 27-31
  • 20 Linna T, Tervo T. Real-time confocal microscopic observations on human corneal nerves and wound healing after excimer laser photorefractive keratectomy. Curr Eye Res 1997; 16: 640-649
  • 21 Patel SV, Erie JC. Aberrant regeneration of corneal nerves after laser in situ keratomileusis. J Cataract Refract Surg 2003; 29: 387-389
  • 22 Perez-Gomez I, Efron N. Confocal microscopic evaluation of particles at the corneal flap interface after myopic laser in situ keratomileusis. J Cataract Refract Surg 2003; 29: 1373-1377
  • 23 Ruckhofer J, Bohnke M, Alzner E et al. Confocal microscopy after implantation of intrastromal corneal ring segments. Ophthalmology 2000; 107: 2144-2151
  • 24 Sonigo B, Iordanidou V, Chong-Sit D et al. In vivo corneal confocal microscopy comparison of intralase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis. Invest Ophthalmol Vis Sci 2006; 47: 2803-2811
  • 25 Stachs O, Zhivov A, Kraak R et al. Structural-functional correlations of corneal innervation after LASIK and penetrating keratoplasty. J Refract Surg 2010; 26: 159-167
  • 26 Nubile M, Dua HS, Lanzini M et al. In vivo analysis of stromal integration of multilayer amniotic membrane transplantation in corneal ulcers. Am J Ophthalmol 2011; 151: 809-822
  • 27 Niederer RL, Perumal D, Sherwin T et al. Corneal innervation and cellular changes after corneal transplantation: an in vivo confocal microscopy study. Invest Ophthalmol Vis Sci 2007; 48: 621-626
  • 28 Misra S, Craig JP, McGhee CN et al. Interocular comparison by in vivo confocal microscopy of the 2-dimensional architecture of the normal human corneal subbasal nerve plexus. Cornea 2012; , Jan 17 [epub ahead of print]
  • 29 Patel DV, McGhee CN. Mapping of the normal human corneal sub-Basal nerve plexus by in vivo laser scanning confocal microscopy. Invest Ophthalmol Vis Sci 2005; 46: 4485-4488
  • 30 Messmer EM, Schmid-Tannwald C, Zapp D et al. In vivo confocal microscopy of corneal small fiber damage in diabetes mellitus. Graefes Arch Clin Exp Ophthalmol 2010; 248: 1307-1312
  • 31 Hamrah P, Cruzat A, Dastjerdi MH et al. Corneal sensation and subbasal nerve alterations in patients with herpes simplex keratitis: an in vivo confocal microscopy study. Ophthalmology 2010; 117: 1930-1936
  • 32 Patel DV, McGhee CN. Laser scanning in vivo confocal microscopy demonstrating significant alteration of human corneal nerves following herpes zoster ophthalmicus. Arch Neurol 2010; 67: 640-641
  • 33 Hau SC, Dart JK, Vesaluoma M et al. Diagnostic accuracy of microbial keratitis with in vivo scanning laser confocal microscopy. Br J Ophthalmol 2010; 94: 982-987
  • 34 Chiou AG, Chang C, Kaufman SC et al. Characterization of fibrous retrocorneal membrane by confocal microscopy. Cornea 1998; 17: 669-671
  • 35 Hillenaar T, Weenen C, Wubbels RJ et al. Endothelial involvement in herpes simplex virus keratitis: an in vivo confocal microscopy study. Ophthalmology 2009; 116: 2077-2086
  • 36 Patel DV, Grupcheva CN, McGhee CN. In vivo confocal microscopy of posterior polymorphous dystrophy. Cornea 2005; 24: 550-554
  • 37 Pouliquen Y. Doyne lecture keratoconus. Eye (Lond) 1987; 1 (Pt 1) 1-14
  • 38 Sherwin T, Brookes NH, Loh IP et al. Cellular incursion into Bowmanʼs membrane in the peripheral cone of the keratoconic cornea. Exp Eye Res 2002; 74: 473-482
  • 39 Niederer RL, Perumal D, Sherwin T et al. Laser scanning in vivo confocal microscopy reveals reduced innervation and reduction in cell density in all layers of the keratoconic cornea. Invest Ophthalmol Vis Sci 2008; 49: 2964-2970
  • 40 Mazzotta C, Balestrazzi A, Traversi C et al. Treatment of progressive keratoconus by riboflavin-UVA-induced cross-linking of corneal collagen: ultrastructural analysis by Heidelberg Retinal Tomograph II in vivo confocal microscopy in humans. Cornea 2007; 26: 390-397
  • 41 Mazzotta C, Traversi C, Baiocchi S et al. Corneal healing after riboflavin ultraviolet-A collagen cross-linking determined by confocal laser scanning microscopy in vivo: early and late modifications. Am J Ophthalmol 2008; 146: 527-533
  • 42 Messmer EM, Mayer P, Herwig MC et al. Morphologic and immunohistochemical changes following corneal crosslinking. Cornea 2012; , May 10 [epub ahead of print]
  • 43 Le QH, Wang WT, Hong JX et al. An in vivo confocal microscopy and impression cytology analysis of goblet cells in patients with chemical burns. Invest Ophthalmol Vis Sci 2010; 51: 1397-1400
  • 44 Villani E, Beretta S, Galimberti D et al. In vivo confocal microscopy of conjunctival roundish bright objects: young, older, and Sjogren subjects. Invest Ophthalmol Vis Sci 2011; 52: 4829-4832
  • 45 Messmer EM, Zapp DM, Mackert MJ et al. In vivo confocal microscopy of filtering blebs after trabeculectomy. Arch Ophthalmol 2006; 124: 1095-1103
  • 46 Peebo BB, Fagerholm P, Traneus-Rockert C et al. Cellular-level characterization of lymph vessels in live, unlabeled corneas by in vivo confocal microscopy. Invest Ophthalmol Vis Sci 2010; 51: 830-835
  • 47 Kobayashi A, Sugiyama K. In vivo corneal confocal microscopic findings of palisades of Vogt and its underlying limbal stroma. Cornea 2005; 24: 435-437
  • 48 Hu VH, Weiss HA, Massae P et al. In vivo confocal microscopy in scarring trachoma. Ophthalmology 2011; 118: 2138-2146
  • 49 Messmer EM. In vivo confocal Microscopy in healthy Conjunctiva, Conjunctivitis, and conjunctival Tumors. In: Reinhard T, ed. Essentials in Ophthalmology. Heidelberg: Springer Verlag; 2008: 213-223
  • 50 Labbe A, Gheck L, Iordanidou V et al. An in vivo confocal microscopy and impression cytology evaluation of pterygium activity. Cornea 2010; 29: 392-399
  • 51 Alomar TS, Nubile M, Lowe J et al. Corneal intraepithelial neoplasia: in vivo confocal microscopic study with histopathologic correlation. Am J Ophthalmol 2011; 151: 238-247
  • 52 Grossniklaus HE, Green WR, Luckenbach M et al. Conjunctival lesions in adults. A clinical and histopathologic review. Cornea 1987; 6: 78-116
  • 53 Damato B, Coupland SE. Conjunctival melanoma and melanosis: a reappraisal of terminology, classification and staging. Clin Experiment Ophthalmol 2008; 36: 786-795
  • 54 Villani E, Ceresara G, Beretta S et al. In vivo confocal microscopy of meibomian glands in contact lens wearers. Invest Ophthalmol Vis Sci 2011; 52: 5215-5219
  • 55 Wei A, Hong J, Sun X et al. Evaluation of age-related changes in human palpebral conjunctiva and meibomian glands by in vivo confocal microscopy. Cornea 2011; 30: 1007-1012
  • 56 Ibrahim OM, Matsumoto Y, Dogru M et al. The efficacy, sensitivity, and specificity of in vivo laser confocal microscopy in the diagnosis of meibomian gland dysfunction. Ophthalmology 2010; 117: 665-672
  • 57 Kojima T, Ishida R, Sato EA et al. In vivo evaluation of ocular demodicosis using laser scanning confocal microscopy. Invest Ophthalmol Vis Sci 2011; 52: 565-569