In Vivo Confocal Microscopy and Diagnosis of Limbal Stem Cell Deficiency. Photographing the Palisades of Vogt and Limbal Stem Cells

The interesting paper by Nubile and associates demonstrates the utility of confocal microscopy in evaluating limbal stem cell deficiency and the palisades of Vogt. Their technique involves a water immersion objective lens coupled to the cornea with a polyacrylic gel and topical anesthesia. The authors state that “low patient compliance and eye movements could preclude the correct visualization of the desired corneal and limbal structures … acquisitions are relatively time-consuming and required skilled examiners for a complete examination of the total corneal surface and all limbal structures.” In this regard it is worth noting that the limbal palisades of Vogt and the interdigitating rete ridges of epithelial cells are rather easily and quickly photographed via routine noncontact slit-lamp photography with or without fluorescein angiography. The high quality of such simply acquired photographs permits quantification of the number, type, dimensions, and location of the rete ridges.