Corneo–conjunctival leukoplakia: histology and confocal microscopy

Purpose: To explore corneo-conjunctival leukoplakias using in vivo confocal microscope and to compare images to histology and impression cytology specimens. Methods: Twenty-nine patients affected by corneo-conjunctival leukoplakia, after evaluation with slit lamp exam, were investigated with the Heidelberg Retina Tomograph II, Rostock Cornea Module. Subsequently a diagnostic excision or impression cytology of the cornea and/or conjunctiva was performed. Results: Histology identified seventeen Pterygia, six Pingueculas, two limbal stem cell deficiency (LSCD), one suture-related corneal vascularization, one cicatricial Pterygoid and two corneal intraepitelial neoplasias (CIN). Confocal microscopy was compared to histopathologic sections and impression citology specimens. In all patients typical white colour of lesions was attribuable to a different degree of reactive hyperkeratosis. The main pathological features were visible on our confocal microscopy images: infiltration of conjunctival tissue surrounding lesions, vascularization, cellular morphology and activity, changes in extracellular matrix and modifications of limbar architecture. Conclusions: Confocal microscopy may be a useful aid for diagnosis and follow up in primitive and secondary corneo-conjunctival lesions. However the ability to provide high resolution, real-time images of the full thickness of the living human cornea and conjunctiva is strictly dependent on surface transparency and additional studies are required to establish exact correlations between confocal microscopy images and histopatology.