Ex Vivo Fluorescence Confocal Microscopy for Intraoperative Diagnosis and Management of Conjunctival Neoplasia
To evaluate the potential use of fluorescent confocal microscopy (FCM) for intraoperative ex vivo diagnosis, staging and excision margins assessment of conjunctival neoplasia.
Conjunctival lesions were excised in toto using a standard no-touch technique by a single surgeon (AI). Collected specimens were examined with a commercially available laser scanning fluorescent microscope (Vivascope 2500; CaliberID) after immersion in a 0.6-m M solution of acridine orange dye for 10–20 seconds. Specimens were subsequently sent for standard histological analysis. All patients were followed post-operatively for a minimum of 6 months.
Eight consecutive patients were included in the study (5M, 3F; median age 65 years; range: 23-90). The time needed to process and analyze a sample was ≤ 8 minutes. FCM was able to identify the nature (6/8 squamous: 1 benign papilloma, 1 grade 2 CIN, 3 in situ squamous carcinomas, 1 microinvasive carcinoma; 2 non-squamous: scleral elastofibroma, lymphoma), margins and depth of invasion of the lesions. FCM-guided micrographic excision was completed in all cases. All FCM findings were confirmed by subsequent histopathological analysis. None of the patients experienced recurrence during the follow time (average: 10 months: range: 6-13).
FCM provides an ultra-fast ex vivo intra-operative diagnosis of suspect conjunctival lesions with excellent histological details and margins assessment. FCM may represent a novel tool for surgical and post-surgical management of conjunctival neoplasia. Use of FCM for in vivo diagnosis of neoplasia is currently under investigation.