Hypertension Clinical Trial
Official title:
Heidelberg Retina Tomograph (HRT) in Vivo Confocal Microscopy to Evaluate the Ocular Surface Disorders of Healthy and Diseased Individuals
In vivo confocal microscopy (IVCM) has been used in clinical settings for more than 25 years, and is noninvasive, rapid and easily repeatable technique to investigate ocular surface disorders. It enables morphological and quantitative analysis of ocular surface microstructure. [1-3] As the technology advances, new IVCM machine, Heidelberg Retinal Tomograph with Rostock Corneal Module (HRT-RCM), was developed. Hardware and software modifications and acquisition techniques continue to expand the applications of the HRT-RCM for quantitative in vivo corneal imaging at the cellular level. The new software can access the corneal nerve more accurate. Here the investigators proposed this Institutional Review Board (IRB) to collect healthy persons and cases of different systematic diseases as well as etiologies of ocular surface diseases.
Heidelberg Retina Tomograph (HRT) in vivo Confocal Microscopy to Evaluate the Ocular Surface
Disorders of Healthy and Diseased Individuals
The purpose of this study is to evaluate the cornea of healthy persons and cases of
differ-ent systematic diseases as well as etiologies of ocular surface diseases.
1. In vivo confocal microscopy (IVCM)
Three main confocal systems have been developed for IVCM:
1. the Tandem Scanning Confocal Microscope (TSCM) [4-6]
2. the ConfoScan 4 (Nidek Technologies Srl, Padova, Italy) [7-8]
3. the Heidelberg Retinal Tomograph with Rostock Corneal Module (HRT-RCM, Heidelberg
Engineering, Ges.m.b.H., Dossenheim, Germany [9-10] The HRT-RCM is a laser scanning
confocal microscope, operating by scanning a 670 nm laser beam in a raster pattern over
the field of view. The system uses a high numerical aper-ture 63x objective lens (0.9
NA), and produces images with high contrast and better axial resolution (7.6 µm) than
other in vivo confocal systems (9 µm for the TSCM and 24 µm for the ConfoScan). The
HRT-RCM provides new built-in software for 3D imaging of the corneal structure.
Quantitative imaging of the subbasal nerve plexus could be performed by CCMetrics sys-tem, a
custom software program developed at the University of Manchester. [11-12] The IVCM has the
advantage of imaging through moderately opaque tissues (scarring or edema of the cornea) and
also observes the dynamic process in the cornea, i.e. inflammatory reaction monitoring in
infectious keratitis, wound healing after refractive surgery.[13-14]
The use of IVCM in the scientific research has been expanding rapidly over the past years. It
has also been implemented for the clinical diagnosis of different ocular surface conditions
as well as screening tool for patients undergoing treatment. The following are indication of
IVCM:
1. Normal central cornea (aging, contact lens wear-related changes)
2. Dry eye disease
3. Corneal ectatic disorders, dystrophies, degenerations
4. Iridocorneal endothelial syndrome (ICE) syndromes
5. Keratitis (microbial, fungal, parasitic, viral)
6. Post-surgical evaluation of the cornea (cataract surgery, Laser ASsisted In situ
Keratomileusis-LASIK, Laser Epithelial Keratomileusis-LASEK, Photorefractive
keratectomy, keratoplasty)
7. Corneal deposits (pseudoexfoliation syndrome, drug-induced )
8. Systemic diseases (DM, Parkinson's disease, systemic lupus erythematosus, Rheumatoid
arthritis, Alzheimer's disease and dementia)
9. Evaluation of the conjunctiva ( conjunctivitis, neoplasia )
10. Limbal stem cell deficiency ( chemical or thermal injury, Stevens-Johnson syndrome )
Study procedures Before examination, each patient signs the written informed consent. The
patients undergo HRT in vivo confocal microscopy. Theses exam will be repeated every 3-6
months according to the disease status. In vivo confocal microscopy is routinely used
examination modality for ocular surface disorders.
(1) In vivo confocal microscopy In vivo confocal microscopy was performed with the HRT in
vivo confocal microscopy real-time confocal microscope (Heidelberg Engineering, Ges.m.b.H.,
Dossenheim, Germany) . Its auto-scan software provides the automatic alignment and recording.
The results would be analyzed using CCMetrics system, a custom software program developed at
the University of Manchester.
Before examination, one drop of topical anesthetic solution (proparacaine 0.5%, Alcaine) was
instilled onto the ocular surface. After proper preparation, one drop of Vidisic gel (Bausch
& Lomb, Ges.m.b.H., Berlin, Germany) was applied. The patients were instructed to gaze in the
direction opposite to the region of measurement. The scanning was performed continuously from
the superficial conjunctiva to the stromal layer
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