In Vivo Confocal Microscopy Changes in Patients with Ocular Surface Neoplasia Following Treatment

Abstract

Abstract Purpose: To examine the changes in ocular surface squamous neoplasia (OSSN) treated with interferon alpha-2b (IFN alpha-2b) and/or surgical excision by in vivo confocal microscopy (IVCM). Methods: This is a retrospective interventional case series. Six patients with suspected unilateral ocular surface neoplasia were examined by color photographs and IVCM before and 1, 2 and 6-12 months after treatment with either interferon (IFN) alpha-2b and/or surgical excision. In cases of surgical excision, pathological examination for ocular surface squamous neoplasia was obtained. IVCM images were focused on the epithelial layer, and cell area and hyperreflectivity of the superficial epithelium (SE) layer was quantified and compared to 6 age- and sex-matched control eyes. Results: In vivo confocal microscopy (IVCM) done at the pre-treatment visits revealed both quantitative and qualitative changes in the epithelial layers of all the patients. Significant increase in cell area (1589.5 ± 246.4 µm2) vs. controls (431.0 ± 24; P<0.001) and hyperreflectivity (50.7 ± 5.2%) vs. controls (2.2 ± 0.2%; P<0.001) were noted. The patients showed improvement in the epithelial configuration post-treatment. A significant decrease was seen in both cell area (601.0 ± 34.8; p=0.001) and hyperreflectivity (11.1 ± 0.4%; P<0.001) Conclusion: IVCM reveals significant quantitative and morphological changes in the epithelium of patients with OSSN, which can be reversed with topical and surgical treatment. Our findings suggest that IVCM is a noninvasive method that allows monitoring the efficacy of OSSN treatment with IFN alpha-2b and/or surgical excision.