Optical Biopsy of Corneal-Conjunctival Intraepithelial Neoplasia Using Ultra-High Resolution Optical Coherence Tomography

Abstract

Purpose: : To report the use of a custom built ultra high resolution anterior segment optical coherence tomography (UHR-OCT) as an optical biopsy for the diagnosis of corneal intraepithelial neoplasia (CIN).

Methods: : A custom built UHR-OCT with a 3µm axial resolution was used to image seven patients with a suspected clinical diagnosis of CIN. An appropriate scanning region was located either by adjusting the UHR-OCT head or by directing the patient to follow a fixation light in order to focus on the ocular pathology. Diagnosis of CIN was confirmed by biopsy in all cases, and compared with the optical images.

Results: : UHR-OCT images of CIN demonstrated a thickened, disorganized layer of epithelium rather than normal overlying epithelium and an abrupt transition from normal to neoplastic epithelium. The images of the UHR-OCT were correlated to the pathologic specimens. The lesions demonstrated faulty epithelial maturational sequencing extending up to full thickness with no invasion in the underlying tissue. Actinic change in the substantia propria from some microscopic examination of CIN cases could be correlated with a hyper-reflectivity on the UHR-OCT images. The neoplasia was limited to the epithelium and did not invade the Bowman’s layer in both optical and pathological specimens.

Keywords: imaging/image analysis: clinical • tumors • cornea: epithelium