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[Study on the evaluation of pterygium activity with in vivo confocal microscopy]
1Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab., Beijing 100005, China.
Insights
In vivo confocal microscopy (IVCM) effectively assesses pterygium activity by quantifying inflammatory cells and vascularization. This method correlates well with traditional pterygium activity scores, offering a reliable diagnostic tool.
Area of Science:
- Ophthalmology
- Confocal Microscopy
- Corneal Diseases
Background:
- Pterygium is a common ocular condition characterized by fibrovascular growth on the cornea.
- Assessing pterygium activity is crucial for determining appropriate treatment and monitoring progression.
- Traditional methods for evaluating pterygium activity may lack detailed cellular and vascular insights.
Purpose of the Study:
- To characterize pterygium features using in vivo confocal microscopy (IVCM).
- To evaluate pterygium activity based on inflammatory cell density, neovascularization, and activated keratocytes.
- To correlate IVCM findings with traditional pterygium activity scores (PAS).
Main Methods:
- A prospective case-controlled study involving 36 pterygia from 28 patients.
- Pterygium activity was scored using a Pterygium Activity Score (PAS) system.
- Quantitative IVCM analysis was performed to assess corneal-pterygium boundaries, goblet cells, inflammatory cells, and Fuchs' patches.
Main Results:
- IVCM revealed inflammatory cells, neovascularization, and irregular corneal-pterygium boundaries in active pterygia.
- Active pterygia (PAS ≥ 4) showed significantly higher densities of dendritiform inflammatory cells, activated keratocytes, and goblet cells compared to inactive pterygia.
- A significant positive correlation was found between IVCM-based activity assessment and the traditional PAS.
Conclusions:
- Quantitative IVCM analysis of inflammatory cells, vascular proliferation, and activated keratocytes provides a reliable method for evaluating pterygium activity.
- IVCM offers detailed insights into the cellular and vascular characteristics associated with pterygium progression.
- This technique may enhance the diagnostic accuracy and monitoring of pterygium.
Abstract:
Objective: To observe the characteristics of pterygium with in vivo confocal microscopy (IVCM) and understand pterygium activity with the density of inflammatory cells, formation of new blood vessels, and the number of activated keratocytes within the stroma. Methods: A prospective case-controlled study. Thirty-six pterygia from 28 patients were analyzed in this study. A pterygium activity score was obtained by summing four scores of ocular discomfort, pterygium hyperemia, keratitis, and the presence of Fuchs patches. Among them, the low activity of pterygium (PAS score less than 3 points) appeared in 12 eyes and high activity of pterygium (PAS score ≥ 4 points) in 24 eyes. All Patients underwent pterygium IVCM quantitative analysis by observing the boundaries between the pterygium and the adjacent cornea, the density of goblet cells and dendritiform inflammatory cells and Fuchs patches. The correlation of pterygium activity between IVCM and PAS with slit lamp was analyzed with Spearman correlation analysis. Results: The presence of inflammatory cells, numerous blood vessels, and irregular boundary between the cornea and the pterygium with infiltration of hyper-reflective cells in the adjacent corneal epithelium were signs observed with IVCM associated with pterygium activity. With IVCM technique, epithelial cells, goblet cells, and dendritiform inflammatory cells of various sizes were observed within the pterygium epithelium.The active (PAS ≥4) pterygium showed irregular boundaries between the pterygium and the adjacent cornea (score, 0.84±0.51) comparing with inactive subjects (score 0.23±0.12, t=2.68, P=0.009). Fuchs patches were observed as islets of hyper-reflective polygonal cells in front of the pterygium head with blurred boundary. The score (0.75±0.25) in active group showed significant changes as compared with normal subjects (0.23±0.12, t=3.79, P=0.001). The score of dendritiform inflammatory cells, activated keratocytes, and goblet cells in active group were 2.75±0.76, 1.92±0.68, and 2.08±0.42, which were significantly higher than those in inactive group (1.25±0.55, 0.50±0.25, 1.15±0.32, P=0.035, 0.030, <0.01). There was significant positive correlation between IVCM activity and traditional slit lamp PAS. Conclusion: Quantitative analysis of dendritiform inflammatory cells, vascular proliferation and activated keratocytes of pterygium by IVCM may be a reliable evaluation method to evaluate the activity of pterygium.(Chin J Ophthalmol, 2016, 52: 755-763).
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