New device to applanate full thickness eyelid tumours for ex vivo confocal microscopy

Abstract

PurposeImmediate confirmation of the suspected diagnosis and verification of margin clearances are of crucial importance during surgery of eyelid tumours. In a multidisciplinary approach with Dermatologist, Ophthalmologist and Pathologist to increase treatment efficiency of these patients, we use a combination of handheld Dermatology in vivo confocal microscope to obtain pseudo histology and ex vivo confocal microscopy (EVCM, Lucid, NY) on fresh tissue to better study margins. Tissues are always fixed for standard pathology. In our first uses of the EVCM, tissue thickness and irregularity hinder from obtaining a full map of the tumour because some parts were not in contact with the glass slide. We designed a specific device to applanate the tissue.MethodsThe prototype device was composed of a 3D printed plastic slide comprising 2.5 mm diameter tapped holes, and a slider destined to a standard glass slide. Thirty screws allowed precisely adjusting the distance between both plans. The tissue was placed on the glass slide, covered by a thin plastic sheet and by the slide with screws. By gently adjusting individual screws, the tissue could be evenly applanated in front of the EVCM. The pathologist assessed whether the device damaged the tissue.ResultsWithout controlled applanation all tissues were only partially mapped. The applanator allowed obtaining a full map of the tissue in all cases with gentle local adjustments directly controlled by the image quality obtained in live. No significant damage was noted.ConclusionsThis simple applanator is useful to improve image quality obtained with the EVCM on full thickness complex tissue like eyelids tumours.