[Contribution of in vivo confocal microscopy to diagnosis of invasive ocular surface squamous neoplasia: a case report]. / Apport de la microscopie confocale in vivo dans les formes invasives de néoplasie malpighienne de la surface oculaire: à propos d'un cas.

INTRODUCTION: Ocular surface squamous neoplasia (OSSN) is the most common conjunctival and limbic malignant tumor that could resemble a pterygium in the early phase of the disease. CASE REPORT: We report the case of a woman who presented with a limbic tumor of the left eye that was mistakenly diagnosed as a pterygium. An in vivo confocal microscopy examination using the HRTII Rostock Cornea Module and a surgical biopsy were performed. The in vivo confocal microscopy findings and the slit lamp examination showed characteristics that strongly supported the diagnosis of OSSN, and the histological examination of both biopsy and surgical exeresis (exenteration) confirmed the diagnosis of epidermoid carcinoma. CONCLUSION: This case report underlines the value of in vivo confocal microscopy in the diagnosis of OSSN, particularly epidermoid carcinoma. This device could be helpful for the early differential diagnosis with pterygium.

[Advantages of in vivo confocal microscopy for investigation of the pterygium]. / Apport de la microscopie confocale in vivo à l'étude des ptérygions.

PURPOSE: To describe the pterygium structure with a high-resolution in vivo confocal microscope and to show the typical components of active pterygium. METHODS: In this study, 15 patients with 20 pterygia were examined. None of them had had prior pterygium surgery. Slit lamp examination and in vivo confocal microscopy imaging (Heidelberg Retina Tomograph II Rostock Cornea Module) were performed. RESULTS: The images obtained consisted of two-dimensional high-resolution optical sections. We could identify the pterygial epithelium and its border, pterygial stroma and its vascularization, the pterygium corneal limits, and numerous inflammatory cells in active pterygia. DISCUSSION: Many reports have been written about pterygium structure. In vivo confocal microscopy imaging is a new approach to this pathology and provides a precise evaluation of active pterygium.

High-resolution magnetic resonance imaging of the upper eyelid: correlation with the position of the skin crease in the upper eyelid.

PURPOSE: The position and appearance of the upper eyelid crease is one of the challenges in eyelid surgery. The aim of this study was to compare the clinical appearance of the upper eyelid crease with its anatomy, including the position of the levator, the septum, and the orbital fat as determined by Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: Oculoplastic examination was performed in normal volunteers of the same age with different appearances of the upper eyelid. MRI (Intera 1.5 T, Philips, the Netherlands) was carried out with both head and surface coils in all volunteers. Subjects were asked to keep their eyes closed during the whole procedure, thus reducing artefacts due to eyeball movements. The protocol lasted 8 minutes and included a multiplanar scout to obtain T1-weighted 3D-images. Thin sagittal T2 sequences were obtained along the plane of the optic nerve and focused on both orbits, allowing a precise analysis of the orbital content and eyelid anatomy. RESULTS: Six volunteers were included in this prospective study, three of Caucasian origin and three of North African, Central African and Asian origin, respectively. We distinguished two appearances of the crease: in some cases, the superior eyelid sulcus was convex, while in other cases it was concave. The superior eyelid fold was either high or low. Two Caucasian subjects had a deep, concave superior eyelid sulcus with a high crease. This crease appearance was correlated with a short concave appearance of the septum, which pulled back the pre-aponeurotic fat. The non-Caucasian volunteers all had a convex superior eyelid sulcus. The orbital septum insertion was low on the levator aponeurosis, and the orbital fat pad drooped onto the levator muscle, accounting for the convexity of the upper eyelid sulcus. A skin fold was formed by redundant skin over the crease. CONCLUSIONS: MRI provides excellent images and allows a good analysis of the upper eyelid components. It permits a detailed analysis of the architecture for a better understanding of its appearance and of the crease position, although further investigation with a larger number of volunteers is required.