Spectral Domain Optical Coherence Tomography Imaging of Ocular Surface Lesions

Abstract

 

Purpose

 

To evaluate ocular surface tumors with anterior segment spectral domain optical coherence tomography (SDOCT).

 

Methods

 

This was an IRB approved retrospective review of patients diagnosed with ocular surface lesions at Duke Eye Center from 2010-2013 who had anterior segment SDOCT imaging (Spectralis; Heidelberg). SDOCT images were analyzed for the following: visibility of tumor margins, presence of cysts, posterior tumor shadowing, and presence of deep invasion. Measurements were made on ImageJ. Correlation was made with histopathology specimens when available.

 

Results

 

9 patients met entry criteria and had the following clinical diagnoses: pterygium (11%, Figures 1 and 2), ocular surface squamous neoplasia (22%), nevus (11%), primary acquired melanosis (11%), and unknown with no biopsy (44%). The nevus and PAM lesion were pigmented, while the rest (77%) were flesh-colored or amelanotic. 11% involved cornea only, 44% cornea-limbus-conjunctiva, and 44% conjunctiva only. By SDOCT, the lesion borders were clearly identified as follows: all borders (55%), anterior (100%), posterior (77%), and at least one lateral margin (100%). The median lesion thickness was 366 μm (range 211-501 μm). Of 5 lesions involving the cornea, the corneal layers could be identified in 80%. Of 8 lesions involving the conjunctiva, the underlying sclera-uveal track could be seen in 50%. The posterior margin was not visible in 2 cases due to posterior tumor shadowing. Both of these lesions were not deeply pigmented and were instead solid, flesh-colored lesions. Intra-tumor cysts with SDOCT were noted in only 1 case (pterygium). Of the 5 cases with histopathology, 1 was determined to be invasive squamous cell carcinoma. This invasion was not visible on OCT because the full lateral extent where the invasion occurred was not imaged.

 

Conclusions

 

Anterior segment SDOCT can be a useful adjunctive tool in the evaluation of ocular surface tumors. However, occasionally posterior tumor shadowing can limit analysis of depth of invasion. In these cases ultrasound biomicroscopy should be considered. For thorough analysis of the lesion, all margins should be imaged necessitating newer imaging protocols to account for lesion thickness and spatial distribution of margins.

 

 

Figure 1. An atypical conjunctival lesion with a feeder vessel that was diagnosed as a pterygium on pathology.

 

 

Figure 2. The SDOCT image shows the lesion is well-circumscribed and not invasive.

 

Keywords: 550 imaging/image analysis: clinical • 744 tumors • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)