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1769114 
Journal Article 
In Vivo Cross-Sectional Observation and Thickness Measurement of Bulbar Conjunctiva Using Optical Coherence Tomography 
Zhang, X; Li, Q; Liu, B; Zhou, H; Wang, H; Zhang, Z; Xiang, M; Han, Z; Zou, H 
2011 
Yes 
Investigative Ophthalmology and Visual Science
ISSN: 0146-0404
EISSN: 1552-5783 
52 
10 
7787-7791 
21873655 
WOS:000295467200099 
PURPOSE. To observe in vivo bulbar conjunctival structures,
and determine the reproducibility of thickness measurements of normal human conjunctiva through
optical coherence tomography (OCT) images. METHODS. The bulbar conjunctivas of three study groups
were observed: five enucleated porcine eyes with 20 um thickness aluminum foils inserted beneath
conjunctival stroma; five glaucoma patients with 6-0 thread placed beneath conjunctival stroma
during trabeculectomy; and 18 normal subjects. The cross-sectional conjunctival images were
acquired using the scanning protocol from an optical coherence tomography device (Anterior
Segment 5 Line Raster scanning protocol, Cirrus HD-OCT; Carl Zeiss Meditec, Inc., Dublin, CA).
The thickness of different conjunctival layers was measured using central corneal thickness
measurement software in the 18 normal subjects. Two reproducible parameters-interobserver
(within-subject between-examiners) and intraobserver (within-subject between-date)-were estimated
with intraclass correlation coefficients (ICC). RESULTS. A thin hyporeflective surface layer,
corresponding to the conjunctival epithelium layer, was observed. Beneath it, the conjunctival
stroma appeared hyperreflective and was separated by a demarcation from the underlying
progressively lower reflective Tenon's capsule. The anatomic location of the demarcation, which
represents the loose connection between the conjunctival stroma and Tenon's capsule, was
confirmed by inserting aluminum foil in porcine eyes, and by a 6-0 thread mark in glaucoma
patients' eyes. The average conjunctival epithelium, stroma, and full thickness of the 18 normal
subjects was 47.3 +/- 8.4 um, 190.8 +/- 47.5 um, and 238.8 +/- 51.1 um, respectively. The
intraobserver and interobserver intraclass correlation coefficients ranged from 0.918 to 0.985.
CONCLUSIONS. It is possible to accurately image and measure the cross-sectional structures of the
bulbar conjunctival tissue with high resolution OCT. (Invest Ophthalmol Vis Sci. 2011;52:7787-
7791) DOI:10.1167/iovs.11-7749