The Use of High-Resolution Optical Coherence Tomography in the Diagnosis of Ocular Surface Masqueraders

Abstract

Purpose : To evaluate the utility of anterior segment high-resolution optical coherence tomography (HR-OCT) in guiding the diagnosis and management of clinically ambiguous ocular surface lesions.

Methods : Individuals with a clinically ambiguous ocular surface lesion with slit-lamp photographs (SLP), HR-OCT images, and histopathological examination were included in the study. The presumptive clinical diagnosis based on SLP was compared to the diagnosis suggested by HR-OCT findings and ultimately to the definitive diagnosis by histopathology. The main outcome of this study was the frequency in which HR-OCT findings guided the clinician to the correct diagnosis.

Results : Twenty-two individuals were included in this study with a mean age of 53 ± 20 years, of whom, 59% were male, 86% identified as white and 21% as Hispanic. Seven lesions were epithelial, 3 had an epithelial and a subepithelial component, and 12 were subepithelial. HR-OCT was most effective in discerning lesion location (epithelial, subepithelial, or both), successfully identifying the location in 100% of cases. In terms of the final diagnosis, classic HR-OCT findings were detected in 68.18% of cases while suggestive features were detected in 31.8% of cases. Figure 1A-E.

Conclusions : HR-OCT can be a valuable diagnostic tool, assisting in the differentiation of ambiguous ocular surface lesions. It provides morphological patterns of the lesion aiding in the localization and diagnosis of the mass.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Slit-lamp photography of the right eye of a 61-year-old white Hispanic female referred for a 10-month history of chronic, non-resolving episcleritis (white arrow). b. High-resolution optical coherence tomography (HR-OCT) demonstrates hyperreflective thickening of the epithelium (asterisk) classic for squamous neoplasia. Biopsy confirmed the HR-OCT diagnosis of conjunctival intraepithelial neoplasia. c. Slit-lamp photography shows dramatic clinical resolution of the lesion after treatment with 4 one-week cycles of 5-fluorouracil 1% eye drops. d. HR-OCT reveals normalization of the epithelium (white arrows). Post-treatment biopsies confirmed tumor resolution. e. Thickened epithelium (between arrows) that demonstrates faulty maturational sequencing which extends up to full thickness is present. (Hematoxylin and eosin, original magnification x 100).