Abstract
Purpose :
Benign lymphoid hyperplasia, conjunctival lymphoma and conjunctival amyloidosis are conditions that appear as similar lesions on the ocular surface. The gold standard for the diagnosis is the histopathological and cytologic examination of conjunctival biopsy specimens. With the advent of high resolution anterior segment optical coherence tomography (HR-OCT), an “optical biopsy” can be obtained. This novel technology helps assess tissue anatomy and evaluate for differences in morphology and cellular patterns to distinguish between divergent conditions. We aim to characterize the morphological differences seen in benign lymphoid hyperplasia, conjunctival lymphoma and conjunctival amyloidosis on HR-OCT imaging.
Methods :
A retrospective chart review was performed of patients with benign lymphoid hyperplasia, conjunctival lymphoma or conjunctival amyloidosis by histopathology and/or cytology between 2014 – 2017 at the Bascom Palmer Eye Institute. HR-OCT images obtained on presentation and follow-up were reviewed. Patients were excluded if HR-OCT imaging was not performed on initial presentation.
Results :
3 eyes had benign lymphoid hyperplasia, 15 eyes had conjunctival lymphoma (n=13 MALT, n=1 diffuse large B-cell, n=1 small lymphocytic) and 3 eyes had conjunctival amyloidosis. All conditions appeared as pink or yellow subepithelial lesions clinically but had different features on HR-OCT. In lymphoma, HR-OCT images showed homogenous, dark subepithelial lesions with smooth borders with monomorphic dot like infiltrates corresponding to the infiltration of monoclonal lymphocytes (1A). In contrast, images of amyloidosis showed heterogenous, dark lesions with irregular borders, often containing hyper-reflective linear infiltrates corresponding with amyloid crystal deposits (1B). Images of benign lymphoid hyperplasia also had dark subepithelial lesions, which were denser and more compact (1C).
Conclusions :
This is the first study evaluating features of benign lymphoid hyperplasia, conjunctival lymphoma, and conjunctival amyloidosis using HR-OCT. Overall, the lymphoproliferative lesions were similar in appearance on HR-OCT but were distinct from the findings seen in amyloid lesions. Future studies can further validate this technology’s use with subtler, more challenging lesions.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.