High-Resolution Optical Coherence Tomography as an Adjunctive Tool in the Diagnosis of Corneal and Conjunctival Pathology

Abstract

Purpose To evaluate the use of a commercially-available, high-resolution, spectral-domain optical coherence tomography (HR OCT) device in the diagnosis of corneal and conjunctival pathologies, with a focus on malignant lesions. Methods Eighty-two eyes of 71 patients were enrolled in this prospective case series, including 10 normal eyes, 21 with ocular surface squamous neoplasia (OSSN), 24 with a pterygium or pingueculum, 3 with lymphoma, 18 with pigmented conjunctival lesions (nevus, flat melanosis, or melanoma), and 6 with Salzmann’s nodular degeneration. Subjects were imaged using photography and HR OCT (RTVue, Optovue, Fremont, CA). When clinically indicated, surgery was performed and histopathologic specimens were correlated with OCT images. Results HR OCT was useful in differentiating among various lesions based on optical signs. Specifically, in OSSN, HR OCT findings included epithelial thickening and hyper-reflectivity, whereas pterygia and pinguecula showed a subepithelial mass under thinner epithelium. In lymphoma, a hypo-reflective, homogenous subepithelial mass was observed. Differentiating between pigmented lesions with HR OCT proved more difficult, but certain characteristics could be identified. Eyes with nevi and melanoma both displayed intensely hyper-reflective basal epithelial layers and discrete subepithelial lesions, but could be differentiated by the presence of cysts in nevi and intense shadowing of sublesional tissue in most melanomas. Conclusion We found that a commercially-available HR OCT was a useful non-invasive adjunctive tool in the diagnosis of ocular surface lesions.

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

“…Our observations are similar to those reported by Abou Shousha et al [14] and Nanji et al [18] who reported an epithelium of normal thickness and a regular hyperreflectivity of the basal epithelium with the use of ultra-high- and high-resolution OCT in 8 and 8 cases, respectively [14,18]. Cases of PAM sine pigmento were not observed in this series.…”

“…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].…”

“…Limited studies have investigated other conjunctival lesions such as nevi and melanoma [17,18]. We have analyzed the correlation of clinical, histopathologic and OCT findings of conjunctival and corneal PAM using a commercially available spectral domain anterior segment OCT device.…”

“…In contrast to PAM, conjunctival nevi characteristically have a high likelihood of conjunctival cysts (77-100%) [17] with normal epithelium [17,18]. Both PAM and nevi have an epithelial layer of normal thickness on OCT [14,18].…”

“…Both PAM and nevi have an epithelial layer of normal thickness on OCT [14,18]. In contrast, conjunctival melanoma appears as a hyperreflective, thickened epithelium with extension of hyperreflectivity into the subepithelial layer and significant optical shadowing which may obscure the underlying tissue [14,18].…”