Diagnosis of Ocular Surface Lesions Using Ultra–High-Resolution Optical Coherence Tomography

Shousha, Mohamed Abou; Karp, Carol L.; Canto, Ana Paula; Hodson, Kelly L.; Oellers, Patrick; Kao, Anne; Bielory, Brett P.; Matthews, Jared; Dubovy, Sander R.; Pérez, Víctor L.; Wang, Jianhua

doi:10.1016/j.ophtha.2012.10.025

Cited by 90 publications

(133 citation statements)

References 19 publications

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“…Anterior segment OCT imaging technology provides a noninvasive adjunct diagnostic tool to the gold standard histopathology specimen in ocular surface lesions such as ocular surface squamous neoplasia [14,15,16,17,18]. Limited studies have investigated other conjunctival lesions such as nevi and melanoma [17,18].…”

Section: Discussionmentioning

confidence: 99%

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Primary Acquired Melanosis: Clinical, Histopathologic and Optical Coherence Tomographic Correlation

Alzahrani¹,

Kumar²,

Aziz³

et al. 2015

Ocul Oncol Pathol

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Aim: To assess the use of anterior segment optical coherence tomography (OCT) as an adjuvant diagnostic tool in primary acquired melanosis (PAM) by correlating clinical, histopathologic and anterior segment OCT findings. Methods: Twenty-four patients (24 eyes) with PAM of the conjunctiva, cornea or both were imaged with an anterior segment OCT device (RTVue, model-RT100; Optovue Inc., Fremont, Calif., USA). Results: Histopathologic diagnosis following excisional or incisional biopsy was confirmed in 13 out of 24 patients (54.6%). OCT images showed a characteristic uniformly thick basal epithelial hyperreflective band (about 20 μm thick) and normal thickness of the overlying epithelial layer in all patients (100%). The hyperreflective band on OCT correlated with the basal epithelial melanocytic pigmentation noted on histopathologic examination but did not vary in thickness between cases with or without atypia. Conclusions: The characteristic basal epithelial hyperreflective band with normal overlying epithelium in the absence of cysts observed in all cases by anterior segment OCT correlated with clinical and histopathologic features of conjunctival and corneal PAM. Anterior segment OCT may be helpful as a noninvasive diagnostic tool for PAM. Improvement in resolution is necessary to detect melanocytic hyperplasia and aytpia suggestive of malignant potential.

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Section: Discussionmentioning

confidence: 99%

“…Spectral domain OCT offers higher resolution of approximately 5 µm compared to time domain OCT, with a resolution of 10-18 µm [10,11,12,13]. Spectral domain OCT has been investigated as adjunct in the management of ocular surface lesions for diagnosis, treatment planning and monitoring of response [9,14,15,16]. …”

Section: Introductionmentioning

confidence: 99%

Primary Acquired Melanosis: Clinical, Histopathologic and Optical Coherence Tomographic Correlation

Alzahrani¹,

Kumar²,

Aziz³

et al. 2015

Ocul Oncol Pathol

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“…Regarding UHR-OCT, lesions, which are thickly pigmented lesions or show leukoplakia, tend to impede the penetration of light to deeper tissues, impairing the determination of the posterior limit of the lesion. Optical information at the time of the study was not sufficient to study signs of cellular atypia and was not able to rule out microinvasion (37) . Similar to UHR-OCT, IC may not distinguish in situ from minimally invasive disease (6) .…”

Section: Ic Imaging and Histopathologymentioning

confidence: 98%

“…Excisional biopsy, despite being the most traditional and accurate means, may induce conjunctival scarring, LSCD, and visually disturbing corneal scarring. Due to the multifocal nature of OSSN, surgical excision results in extensive collateral damage to adjacent areas of normal epithelium (37) . In addition to IC, newer diagnostic techniques including CCM (22) , toluidine blue (38) , and ultra-high resolution anterior segment optical coherence tomography (UHR-OCT) (39) have been reported to aid in the diagnosis of OSSN.…”

Section: Ic Imaging and Histopathologymentioning

confidence: 99%

“…No data are available regarding inter-and intraobserver variability for the assessment of ocular surface pathology using the UHR-OCT (40) . Despite UHR-OCT having the advantage over IC of providing relatively deeper scans of the entire epithelium and the underlying tissue, it cannot reliably detect invasion (37) . In addition, UHR-OCT machines are largely limited to academic institutions (39) .…”

Section: Ic Imaging and Histopathologymentioning

confidence: 99%

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Impression cytology in the evaluation of ocular surface tumors: review article

Barros¹,

Almeida²,

Lowen³

et al. 2015

Arquivos Brasileiros De Oftalmologia

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Impression cytology (IC) has been widely used as a method for evaluating the ocular surface and superficial cells layers in the diagnosis and follow-up after treatment of several ocular surface tumors of both epithelial and melanocytic origin. Information regarding this can be found in the English-language literature since 1992. Using either cellulose acetate or Biopore membranes for specimen collection, a high correlation has been found between IC and tissue histology. Compared with exfoliative cytology with spatula, IC is less traumatic to the patient's eye, provides a precise location of the area being studied, and allows accurate observation of the cells the way they exist in vivo. The additional advantage of IC is the preservation of limbal stem cells responsible for continuous corneal epithelium renewal; these can be affected after incisional or excisional biopsy at the corneoscleral limbus, which is the most frequent site of appearance of tumors in the stratified epithelium. Treatment for ocular surface squamous neoplasia has historically included surgery, but nonsurgical interventions have also been adopted. Hence, in certain cases, ophthalmologists may prefer interventions less invasive than surgical biopsy such as of impression cytology for both initial diagnosis and therapeutic monitoring of treatment for ocular surface lesions. Nevertheless, it should be considered that IC may be less helpful if the results conflict with the clinical picture or if the clinical diagnosis is uncertain and results are negative. In such cases, surgical biopsy is required for accurate diagnosis. The purpose of this review is to examine the published literature on the utilization of IC for the diagnosis and management of ocular surface tumors and to discuss the requirement for further investigation on the subject.

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Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Eyelid Margin and Conjunctival Tumors

et al. 2017

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The clinical diagnosis of conjunctival and eyelid margin tumors is challenging, and new noninvasive imaging techniques could be valuable in this field. OBJECTIVE To assess the diagnostic accuracy of handheld in vivo reflectance confocal microscopy (IVCM) for the diagnosis of eyelid margin and conjunctival tumors. DESIGN A prospective observational study was conducted at University Hospital of Saint-Etienne from January 2, 2011, to December 31, 2016 (inclusion of patients until December 31, 2015, and follow-up until December 31, 2016). A total of 278 consecutive patients with eyelid margin or conjunctival lesions were included. Conjunctival lesions were diagnosed with a conventional clinical examination using a slitlamp and by handheld IVCM. Final diagnoses were established by histopathologic examination for 155 neoformations suspicious for being malignant through clinical and/or IVCM examination that were excised and on follow-up of 12 months or longer for the remaining 140 lesions. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, and positive and negative predictive values for malignant tumors of the conjunctiva and eyelid margin were calculated using clinical examination with slitlamp and handheld IVCM. RESULTS In the 278 patients (136 [48.9%] females; mean [SD] age, 59 [21] years), a total of 166 eyelid margin and 129 conjunctival lesions were included in the analysis. Of the 155 excised neoformations with a histopathologic diagnosis, IVCM showed higher sensitivity compared with clinical examination conducted with the slitlamp for malignant tumors of the eyelid margin (98% vs 92%) and conjunctiva (100% vs 88%). The specificity for malignant eyelid margin tumors was higher for IVCM than for slitlamp examination (74% vs 46%), but slightly less for malignant conjunctival tumors (78% vs 88%). Analysis of all neoformations (155 excised and 140 in follow-up) confirmed these differences in the diagnostic accuracy of the clinical examination and IVCM. The presence of hyperreflective Langerhans cells mimicking malignant melanocytes was the main cause for misdiagnosis of malignant conjunctival tumors with IVCM. CONCLUSIONS AND RELEVANCE Handheld IVCM could be a useful tool for the identification of malignant conjunctival tumors. Further studies are required to confirm the usefulness of this device and identify possible features that can differentiate Langerhans cells from malignant melanocytes to prevent the misdiagnosis of melanoma using IVCM.

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Diagnosis of Ocular Surface Lesions Using Ultra–High-Resolution Optical Coherence Tomography

Cited by 90 publications

References 19 publications

Primary Acquired Melanosis: Clinical, Histopathologic and Optical Coherence Tomographic Correlation

Primary Acquired Melanosis: Clinical, Histopathologic and Optical Coherence Tomographic Correlation

Impression cytology in the evaluation of ocular surface tumors: review article

Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Eyelid Margin and Conjunctival Tumors

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