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Herskowitz WR, De Arrigunaga S, Greenfield JA, Cohen NK, Galor A, Karp CL. Can high-resolution optical coherence tomography provide an optical biopsy for ocular surface lesions? CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00214-X. [PMID: 39103154 DOI: 10.1016/j.jcjo.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/31/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024]
Abstract
High-resolution optical coherence tomography (HR-OCT) has transformed the diagnosis and management of ocular surface lesions. Providing a detailed cross-sectional view of the cornea and conjunctiva, HR-OCT can be used to identify characteristic features of various benign and malignant ocular surface lesions, aiding in their diagnosis and guiding treatment. When incorporated into an ophthalmology clinic, HR-OCT provides morphological images of lesions in a noninvasive means, akin to an "optical biopsy". The characteristic HR-OCT features of several lesions have been well described in the literature, including for ocular surface squamous neoplasia, papilloma, melanoma, primary acquired melanosis, complexion associated melanosis, nevus, pterygium, pinguecula, lymphoma, and amyloidosis. HR-OCT can be used to differentiate between lesions with similar clinical features, lesions that co-exist on the same ocular surface, and atypically presenting lesions, such as pigmented ocular surface squamous neoplasia or amelanotic melanoma. The management of ocular surface lesions has been transformed by the implementation of HR-OCT, providing clinicians with the ability to monitor tumor response to topical chemotherapies, follow previously excised lesions for recurrence, and map out tumor borders intraoperatively. While there are some limitations to HR-OCT, including imaging of thick or deep lesions, it has become an essential tool for ocular oncologists in the management of ocular surface lesions.
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Affiliation(s)
| | - Sofia De Arrigunaga
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
| | - Jason A Greenfield
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
| | - Noah K Cohen
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL; Brown University, Providence, RI
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL.
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2
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Tripathy D. Imaging the Conjunctival Nevus in Children: The Utility of an "Optical Biopsy". J Pediatr Ophthalmol Strabismus 2024; 61:300. [PMID: 38482800 DOI: 10.3928/01913913-20240208-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
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3
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Chong YJ, Azzopardi M, Hussain G, Recchioni A, Gandhewar J, Loizou C, Giachos I, Barua A, Ting DSJ. Clinical Applications of Anterior Segment Optical Coherence Tomography: An Updated Review. Diagnostics (Basel) 2024; 14:122. [PMID: 38248000 PMCID: PMC10814678 DOI: 10.3390/diagnostics14020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Since its introduction, optical coherence tomography (OCT) has revolutionized the field of ophthalmology and has now become an indispensable, noninvasive tool in daily practice. Most ophthalmologists are familiar with its use in the assessment and monitoring of retinal and optic nerve diseases. However, it also has important applications in the assessment of anterior segment structures, including the cornea, conjunctiva, sclera, anterior chamber, and iris, and has the potential to transform the clinical examination of these structures. In this review, we aim to provide a comprehensive overview of the potential clinical utility of anterior segment OCT (AS-OCT) for a wide range of anterior segment pathologies, such as conjunctival neoplasia, pterygium, scleritis, keratoconus, corneal dystrophies, and infectious/noninfectious keratitis. In addition, the clinical applications of AS-OCT (including epithelial mapping) in preoperative planning and postoperative monitoring for corneal and refractive surgeries are discussed.
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Affiliation(s)
- Yu Jeat Chong
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Modality Ophthalmology, Modality Partnership, Birmingham B19 1BP, UK;
| | - Matthew Azzopardi
- Department of Ophthalmology, Royal Free Hospital, London NW3 2QG, UK;
| | - Gulmeena Hussain
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK;
| | - Alberto Recchioni
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Jaishree Gandhewar
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK;
| | | | - Ioannis Giachos
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
| | - Ankur Barua
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
| | - Darren S. J. Ting
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Adetunji MO, Cummings TJ, Materin MA, Maniar AS. Melanocytic Nevus of the Superior Conjunctival Fornix: A Case Report. Case Rep Ophthalmol 2024; 15:225-229. [PMID: 38500543 PMCID: PMC10948165 DOI: 10.1159/000537876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Conjunctival nevi are benign tumors that are commonly located at the nasal or temporal limbus and rarely in the fornix or tarsus. We report a case of a patient presenting with a solitary compound cystic nevus of the conjunctival fornix in the background of bilateral complexion-associated melanosis. Case Presentation A 71-year-old African-American female was referred for evaluation of an incidentally noted melanocytic lesion of the right conjunctival fornix. The patient underwent an excisional biopsy, revealing histological features consistent with a compound cystic nevus. Conclusion This finding is noteworthy due to the rarity of conjunctival nevi originating in the fornix. The case underscores the importance of excisional biopsy in evaluating conjunctival forniceal melanocytic lesions to exclude malignant melanoma, a critical consideration for prognosis.
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Affiliation(s)
- Modupe O. Adetunji
- Department of Ophthalmology, Duke University Health System, Durham, NC, USA
| | | | - Miguel A. Materin
- Department of Ophthalmology, Duke University Health System, Durham, NC, USA
| | - Arpita S. Maniar
- Department of Ophthalmology, Duke University Health System, Durham, NC, USA
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Huang JJ, Locatelli EVT, Chocron A, Camacho MR, Dubovy S, Karp CL, Galor A. Conjunctival Nevus. CURRENT OPHTHALMOLOGY REPORTS 2023; 11:104-112. [PMID: 38390435 PMCID: PMC10883671 DOI: 10.1007/s40135-023-00315-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 02/24/2024]
Abstract
Purpose of Review To provide an up-to-date review of the epidemiology, presentation, diagnosis, and treatment options for conjunctival nevi (CN). Recent Findings Around 17.2%-42% of all conjunctival tumors have been found to be CN, which most frequently present in White individuals between the first to early third decade of life, with equal distribution between males and females. CN commonly occur in the interpalpebral bulbar conjunctiva with pigmentation ranging from amelanotic to dark. Diagnosis is typically made through slit lamp examination, visualized by a well circumscribed, variably elevated, variably pigmented, solitary lesion with clear cysts distributed throughout the pigment. In ambiguous cases, anterior segment optical coherence tomography (AS-OCT) can highlight the presence of sub-clinical cysts, whose presence points to a diagnosis of nevus. However, excisional biopsy with histopathology examination is the gold standard for identifying CN. Summary CN are benign, variably pigmented lesions. They are the most common of the conjunctival melanocytic tumors. Due to the extremely low risk of transformation to malignant melanoma (MM), CN are usually managed with routine observation and photo documentation.
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Affiliation(s)
- Jaxon J Huang
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Elyana V T Locatelli
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Alberto Chocron
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Matthew R Camacho
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Sander Dubovy
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th Street, Miami, FL 33136, USA
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, USA
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
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6
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Gündüz AK, Mirzayev I, Okcu Heper A, Kuzu I, Gahramanli Z, Cansiz Ersöz C, Gündüz ÖÖ, Ataoğlu Ö. Anterior segment optical coherence tomography in ocular surface tumours and simulating lesions. Eye (Lond) 2023; 37:925-937. [PMID: 36513855 PMCID: PMC10050214 DOI: 10.1038/s41433-022-02339-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
This study aims to systematically review the reported literature on the use of anterior segment optical coherence tomography (AS-OCT) in ocular surface tumours and simulating lesions. A systematic literature search was done using PubMed, Scopus, and Web of Science databases between January 2002 and December 2021. On AS-OCT, ocular surface squamous neoplasia typically demonstrate epithelial thickening, epithelial hyperreflectivity, and an abrupt transition between normal and abnormal epithelium. Conjunctival nevi usually show mildly hyperreflective epithelium of normal thickness, internal hyperreflectivity, and intralesional cysts which is the hallmark of this tumour. Primary acquired melanosis presents with normal thickness epithelium, basal epithelial hyperreflectivity, and absence of cysts. Conjunctival melanoma demonstrates hyperreflective normal/thickened epithelium, hyperreflective basal epithelium, internal hyperreflectivity, and absence of intralesional cysts. Conjunctival lymphoma shows homogenous, low-medium reflective subepithelial lesions with smooth borders, and dot-like infiltrates. Benign reactive lymphoid hyperplasia findings are similar to lymphoma but the infiltrates are more hyperreflective compared to lymphoma. Pterygium shows thickened conjunctival epithelium, epithelial hyperreflectivity, and subepithelial wedge-shaped hyperreflective tissue separated from the overlying epithelium by a cleavage plane. Pinguecula demonstrates mildly thickened epithelium and similar findings with pterygium but does not extend beyond the corneal limbus. This review shows that AS-OCT, as a noninvasive tool, has potential uses in the differential diagnosis of ocular surface tumours and simulating lesions. Major limitations of AS-OCT include limited visualization of the posterior border of thick, keratinized, and pigmented tumours and lack of assessment of large conjunctival tumours in a single cut.
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Affiliation(s)
- Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.
- Private Eye Clinic, Ankara, Turkey.
| | - Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Department of Ophthalmology, Dünyagöz Hospital, Ankara, Turkey
| | - Aylin Okcu Heper
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Işınsu Kuzu
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Ömür Özlenen Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömür Ataoğlu
- Private Mikro-Pat Pathology Laboratory, Ankara, Turkey
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7
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Sripawadkul W, Khzam RA, Tang V, Zein M, Dubovy SR, Galor A, Karp CL. Anterior segment optical coherence tomography characteristics of conjunctival papilloma as compared to papilliform ocular surface squamous neoplasia. Eye (Lond) 2023; 37:995-1001. [PMID: 36402855 PMCID: PMC10050070 DOI: 10.1038/s41433-022-02309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/24/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To describe the anterior segment optical coherence tomography (AS-OCT) appearance of conjunctival papilloma and identify differentiating features from papilliform ocular surface squamous neoplasia (OSSN). METHOD A retrospective chart review of individuals clinically diagnosed with conjunctival papilloma (n = 10) or papilliform OSSN (n = 10) based on slit lamp features. Data on demographics, tumour characteristics, and primary treatment were collected. AS-OCT features were assessed including epithelial thickness and reflectivity, a corrugated epithelial surface, presence of an overhanging edge, presence of intrinsic spaces and posterior shadowing. Histopathology was available in 5 papilloma and 3 OSSN specimens. RESULT Overall, the majority of individuals in both groups were white males. OSSN lesions were more likely to involve the limbus (80% vs.10%, p = 0.005) and the bulbar conjunctiva (100% vs. 20%, p < 0.001) compared to papillomas. On AS-OCT, maximum epithelial thickness was thicker in papilloma compared to OSSN (936 ± 533 vs. 637 ± 207 µm, p = 0.009). The feature that best differentiated papilloma from OSSN was an overhanging edge (100% vs. 0%, p < 0.001), where the epithelial lesion was seen on top of underlying normal epithelium. Other features more common in papilloma compared to OSSN included a corrugated epithelial surface (70% vs.10%, p = 0.02), the presence of intrinsic spaces (100% vs. 50%, p = 0.03), and posterior shadowing (100% vs. 40%, p = 0.01). CONCLUSION AS-OCT shows differentiating features between papilloma and OSSN with an overhanging edge as a distinctive AS-OCT feature of papilloma.
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Grants
- P30 EY014801 NEI NIH HHS
- Research to Prevent Blindness (RPB)
- NIH Center Core Grant P30EY014801, Dr. Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Robert Farr Family Grant, The Grant and Diana Stanton-Thornbrough, The Robert Baer Family Grant, The Roberto and Antonia Menendez Grant, The Emilyn Page and Mark Feldberg Grant, The Calvin and Flavia Oak Support Fund, The Robert Farr Family Grant, The Jose Ferreira de Melo Grant, The Richard and Kathy Lesser Grant, The Honorable A. Jay Cristol Grant, The Michele and Ted Kaplan Grant, The Carol Soffer Grant, and the Richard Azar Family Grant(institutional grants).
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Affiliation(s)
- Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
- Department of Ophthalmology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Rayan Abou Khzam
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Vincent Tang
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Mike Zein
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
- Florida Lions Ocular Pathology Laboratory, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA.
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8
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Auw-Hädrich C, Gasser L, Reinhard T. Bindehautdegenerationen und -neoplasien. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1488-0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungErhabenheiten der Bindehaut entstehen durch Gewebevermehrung, die entweder degenerativ oder neoplastisch, aber auch entzündlich sein können. In diesem Artikel werden degenerative (Pterygium
und Pinguecula) sowie benigne und maligne neoplastische Bindehautveränderungen (epitheliale, melanozytäre und vaskuläre Tumoren, Choristome sowie Metastasen) bezüglich der Pathogenese,
Symptome, Diagnostik und aktuellem Stand der Behandlung dargestellt.
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9
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Auw-Hädrich C, Gasser L, Reinhard T. [Conjunctival Degeneration and Neoplasia]. Klin Monbl Augenheilkd 2022; 239:823-845. [PMID: 35609810 DOI: 10.1055/a-1831-2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Conjunctival tumors result from gain of tissue, which can be either degenerative or neoplastic, but also inflammatory. In this article, degenerative (pterygium and pinguecula) as well as benign and malignant neoplastic conjunctival changes (epithelial, melanocytic and vascular tumors, choristomas as well as metastases) are discussed with regard to pathogenesis, symptoms, diagnostics and current status of treatment.
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10
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Anterior segment optical coherence tomography angiography in the assessment of ocular surface lesions. Ocul Surf 2021; 22:86-93. [PMID: 34333154 DOI: 10.1016/j.jtos.2021.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/28/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Describe the utility of anterior segment optical coherence tomography angiography (AS-OCTA) to assess ocular surface lesions. METHODS Retrospective, case-control study of 10 eyes of 9 patients with malignant lesions and 23 eyes of 22 patients with benign lesions. Lesions included 13 epithelial, 10 pigmented and 10 lymphoid lesions. Graders performed an average of 3 depth and diameter measurements of peri-lesional vessels entering each lesion on AS-OCTA. Statistical models to assess differences between groups accounted for bilateral eye inclusion and lesion thickness (on AS-OCT). Receiver operating characteristic (ROC) curve and area under the curve (AUC) were performed for each parameter. RESULTS In the benign and malignant groups, age was 49.5 ± 22.4 and 64.3 ± 10.6 years (p = 0.145) with 45% males and 55% males (p = 0.458), in their respective groups. AS-OCTA showed greater peri-lesional vessel depth and diameter in malignant lesions (315.2 ± 73.0 μm, p < 0.001 and 76.4 ± 18.2 μm, p < 0.001; respectively) compared to benign lesions (199.4 ± 34.1 μm and 44.0 ± 9.4 μm, respectively). Malignant lesions showed deep and dilated peri-lesional vessels, which may represent feeder vessels. Vessel depth showed AUC = 0.980, 90.9% sensitivity and 100.0% specificity with a 236.5 μm cutoff. Vessel diameter showed AUC = 0.960, 100.0% sensitivity and 88.9% specificity with a 53.9 μm cutoff. CONCLUSION AS-OCTA shows greater peri-lesional vessel depth and diameter of malignant lesions compared to benign lesions. This imaging modality provides novel and non-invasive functional vascular parameters that can potentially aid the assessment of ocular surface lesions.
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11
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Lauwers N, Janssens K, Mertens M, Mathysen D, Lammens M, de Keizer RJW, De Groot V. Anterior segment optical coherence tomography and ultrasound biomicroscopy for measuring thickness of corneal and bulbar conjunctival tumours. Br J Ophthalmol 2021; 106:760-764. [PMID: 33547035 DOI: 10.1136/bjophthalmol-2018-312337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/18/2020] [Accepted: 01/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/OBJECTIVE Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) are two non-invasive imaging techniques used for the measurement of tumour thickness in corneal and bulbar conjunctival tumours. Histopathology (HP), however, remains the gold standard for the measurement of tumour thickness. The aim of this study was to determine whether AS-OCT and UBM are as accurate as HP for measuring tumour thickness. METHODS Forty-two corneal and bulbar conjunctival tumours were imaged using AS-OCT and UBM. Images were assessed and tumour thickness was measured. Eleven patients subsequently underwent surgical excision. All specimens were measured during histopathological analysis. The correlation of the thickness measurement on HP to AS-OCT and UBM was then statistically analysed. In cases where the tumour was not excised, thickness measurement comparisons between AS-OCT and UBM were analysed. RESULTS AS-OCT and UBM measurements of tumour thickness were found to be significantly positively correlated (p=<0.001), as were UBM and HP thickness measurements (p=0.031). HP and AS-OCT measurements, however, only showed a mild but non-significant positive correlation. CONCLUSION Both AS-OCT and UBM are useful techniques to image and measure the thickness of corneal and conjunctival bulbar tumours. While AS-OCT provides better details than UBM, it was more limited in visualising the posterior boundary of the tumour, particularly in malignant tumours. While thickness measurements of both methodologies were correlated, neither should yet be considered as replacements to the gold standard of HP.
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Affiliation(s)
- Noémie Lauwers
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Katleen Janssens
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Michelle Mertens
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Danny Mathysen
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Martin Lammens
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Rob J W de Keizer
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Veva De Groot
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
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12
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Negretti GS, Roelofs KA, Damato B, Sagoo M, Parvizi S, Cohen VML. The natural history of conjunctival naevi in children and adolescents. Eye (Lond) 2020; 35:2579-2584. [PMID: 33199866 PMCID: PMC7668404 DOI: 10.1038/s41433-020-01273-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The objective of this study is to characterise the natural history of conjunctival naevi in a paediatric and adolescent population. METHODS All children and adolescents referred to Moorfields Ocular Oncology Service for evaluation between January 2015 and 2020 were included. Exclusion criteria included age >20 years old and lack of anterior segment photographs. A total of 77 patients were included with a mean age of 12 years (standard deviation: 3.9; range, 4-20). The main outcome measures were: number of conjunctival naevi that grew, changed in pigmentation, required excisional biopsy, or were histologically malignant. If there was growth, the percentage increase in size was measured. RESULTS At their first visit, 13% of patients (10/77) were discharged to local follow-up and 10% (8/77) proceeded to excisional biopsy, four further patients underwent excisional biopsy after a period of follow-up. On histopathological assessment, 92% (11/12) of lesions were benign conjunctival naevi. One patient, who had suspicious clinical features at presentation, had conjunctival melanoma. Fifty-nine patients were followed over a median of 1.1 years (interquartile range: 1.54; range, 3 months to 4 years). Eight per cent (5/59) of conjunctival naevi enlarged in diameter by a mean percentage increase in size of 2%, whereas 5% (3/59) showed increased pigmentation and 8.5% (5/59) showed decreased pigmentation. CONCLUSIONS Growth of conjunctival naevi in children is infrequent (8%) and the large majority of those excised are benign. Because of a lack of evidence, these patients are often followed for years in ophthalmic practice. This series demonstrates that prolonged follow-up may not be necessary.
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Affiliation(s)
- Guy S Negretti
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.
| | - Kelsey A Roelofs
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK
| | - Bertil Damato
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK
| | - Mandeep Sagoo
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.,NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Sahar Parvizi
- Department of Ophthalmology, Surrey and Sussex Healthcare NHS Trust, Canada Ave, Redhill, RH1 5RH, UK
| | - Victoria M L Cohen
- Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.,NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
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13
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Atalay E, Yu DJ, Nongpiur ME. When to use anterior segment optical coherence tomography. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1767596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Eray Atalay
- Department of Ophthalmology, Eskisehir Osmangazi University Faculty of Medicine, Turkey
| | - Daryle Jason Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Monisha Esther Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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14
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Cinotti E, Campoli M, Grivet D, Perrot JL, Rubegni P. Noninvasive imaging for the diagnosis of melanocytic conjunctival tumor. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1762490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, Siena, Italy
| | - Marco Campoli
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, Siena, Italy
| | - Damien Grivet
- Department of Ophthalmology, University Hospital of Saint-Etienne, France
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, Siena, Italy
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Vizvári E, Skribek Á, Polgár N, Vörös A, Sziklai P, Tóth-Molnár E. Conjunctival melanocytic naevus: Diagnostic value of anterior segment optical coherence tomography and ultrasound biomicroscopy. PLoS One 2018; 13:e0192908. [PMID: 29444155 PMCID: PMC5812659 DOI: 10.1371/journal.pone.0192908] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/13/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose Conjunctival naevi are the most frequently diagnosed primary melanocytic lesions of the conjunctiva. The clinical manifestations are greatly variable which may result in diagnostic difficulties and differential diagnostic confusions. Therefore aims of the present study were: 1) to assess the morphologic features of conjunctival naevi; 2) to delineate the anterior segment optical coherence tomography (AS-OCT) characteristics of these lesions; 3) to compare AS-OCT and ultrasound biomicroscopy (UBM) as diagnostic tools in these alterations and 4) to correlate histological results with the AS-OCT pictures in case of surgically excised naevi. Methods All lesions were photo-documented. AS-OCT and UBM (over the age of 18 years) were performed. Surgically excised lesions were admitted to histological examinations. Results In our series of 57 conjunctival naevi, 54.4% were highly pigmented, 15.8% proved to be amelanotic. AS-OCT could detect intralesional cysts in 61.4% of the naevi, while slit-lamp and UBM proved to be less sensitive (40.3% vs. 28.5%). UBM could visualize the posterior margins of all naevi, while AS-OCT proved to be less sensitive with the detection of 89.4% of posterior naevus margins. Thickness of the conjunctival epithelial layer could be measured with AS-OCT in case of subepithelial naevi, while no distinct epithelial layer could be detected in compound and junctional naevi. Conclusions Superiority of AS-OCT over UBM was demonstrated in visualizing internal structures of conjunctival naevi. UBM proved to be a better tool in highly pigmented and remarkably elevated naevi. Correlation was found between the histological type of the naevus and the thickness of the epithelial layer covering the lesion.
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Affiliation(s)
- Eszter Vizvári
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
| | - Ákos Skribek
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
| | - Nóra Polgár
- “Szemambulancia” Ophthalmology Private Practice, Szeged, Hungary
| | - András Vörös
- University of Szeged, Department of Pathology, Szeged, Hungary
| | - Pál Sziklai
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
| | - Edit Tóth-Molnár
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
- * E-mail:
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Giant Conjunctival Nevus in a 12-Year-Old Child. Case Rep Ophthalmol Med 2017; 2017:8414352. [PMID: 28912992 PMCID: PMC5587934 DOI: 10.1155/2017/8414352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022] Open
Abstract
We describe a case of a giant conjunctival nevus presented in a 12-year-old girl with suspicious clinicomorphological appearance. The lesion was noticed by the parents at the age of 3 years as a “fleshy spot” on the bulbar conjunctiva. The lesion remained unchanged until approx. 6 months before recent admission. On slit-lamp examination, a large conjunctival lesion with variegate pigmentation and indistinct margins was detected on the superonasal part of the bulbar conjunctiva of the left eye. Intralesional cysts and vessels were detected with AS-OCT examination. Wide excision and cryotherapy to the scleral bed were performed and amniotic membrane graft was used to restore the ocular surface. Histopathological examination revealed compound type conjunctival nevus and disclosed any sign of malignancy. Although giant conjunctival nevus is a rare entity, precise diagnosis and adequate management are very important as it can be confused with malignant melanoma.
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Cinotti E, Singer A, Labeille B, Grivet D, Rubegni P, Douchet C, Cambazard F, Thuret G, Gain P, Perrot JL. Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Eyelid Margin and Conjunctival Tumors. JAMA Ophthalmol 2017; 135:845-851. [PMID: 28654937 DOI: 10.1001/jamaophthalmol.2017.2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance The clinical diagnosis of conjunctival and eyelid margin tumors is challenging, and new noninvasive imaging techniques could be valuable in this field. Objective To assess the diagnostic accuracy of handheld in vivo reflectance confocal microscopy (IVCM) for the diagnosis of eyelid margin and conjunctival tumors. Design A prospective observational study was conducted at University Hospital of Saint-Etienne from January 2, 2011, to December 31, 2016 (inclusion of patients until December 31, 2015, and follow-up until December 31, 2016). A total of 278 consecutive patients with eyelid margin or conjunctival lesions were included. Conjunctival lesions were diagnosed with a conventional clinical examination using a slitlamp and by handheld IVCM. Final diagnoses were established by histopathologic examination for 155 neoformations suspicious for being malignant through clinical and/or IVCM examination that were excised and on follow-up of 12 months or longer for the remaining 140 lesions. Main Outcomes and Measures Sensitivity, specificity, and positive and negative predictive values for malignant tumors of the conjunctiva and eyelid margin were calculated using clinical examination with slitlamp and handheld IVCM. Results In the 278 patients (136 [48.9%] females; mean [SD] age, 59 [21] years), a total of 166 eyelid margin and 129 conjunctival lesions were included in the analysis. Of the 155 excised neoformations with a histopathologic diagnosis, IVCM showed higher sensitivity compared with clinical examination conducted with the slitlamp for malignant tumors of the eyelid margin (98% vs 92%) and conjunctiva (100% vs 88%). The specificity for malignant eyelid margin tumors was higher for IVCM than for slitlamp examination (74% vs 46%), but slightly less for malignant conjunctival tumors (78% vs 88%). Analysis of all neoformations (155 excised and 140 in follow-up) confirmed these differences in the diagnostic accuracy of the clinical examination and IVCM. The presence of hyperreflective Langerhans cells mimicking malignant melanocytes was the main cause for misdiagnosis of malignant conjunctival tumors with IVCM. Conclusions and Relevance Handheld IVCM could be a useful tool for the identification of malignant conjunctival tumors. Further studies are required to confirm the usefulness of this device and identify possible features that can differentiate Langerhans cells from malignant melanocytes to prevent the misdiagnosis of melanoma using IVCM.
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Affiliation(s)
- Elisa Cinotti
- Department of Medical, Surgical, and Neurological Science, Dermatology Section, University of Siena, S Maria alle Scotte Hospital, Siena, Italy
| | - Aurélie Singer
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bruno Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Damien Grivet
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical, and Neurological Science, Dermatology Section, University of Siena, S Maria alle Scotte Hospital, Siena, Italy
| | - Catherine Douchet
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gilles Thuret
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France.,French University Institute, Paris, France
| | - Philippe Gain
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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20
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Abstract
Tumors of the Ocular Surface clinically manifest with a very wide spectrum and include several forms of epithelial, stromal, caruncular, and secondary tumors. As a group, these tumors are seen commonly in the clinical practice of a comprehensive ophthalmologist, cornea specialist, and an ocular oncologist. This review is aimed to discuss the common tumors of the ocular surface and emphasize on their clinical diagnosis and appropriate management.
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Affiliation(s)
- Santosh G Honavar
- Department of Ophthalmic Plastic Surgery and Ocular Oncology, Centre for Sight, Hyderabad, India
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To Study and Determine the Role of Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopy in Corneal and Conjunctival Tumors. J Ophthalmol 2016; 2016:1048760. [PMID: 28050274 PMCID: PMC5168478 DOI: 10.1155/2016/1048760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/23/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. To analyze and describe corneal and conjunctival tumor thickness and internal characteristics and extension in depth and size and shape measured by two noninvasive techniques, anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). Design. Systematic review. Methods. This systematic review is based on a comprehensive search of 4 databases (Medline, Embase, Web of Science, and Cochrane Library). Articles published between January 1, 1999, and December 31, 2015, were included. We searched for articles using the following search terms in various combinations: “optical coherence tomography”, “ultrasound biomicroscopy”, “corneal neoplasm”, “conjunctival neoplasm”, “eye”, “tumor” and “anterior segment tumors”. Inclusion criteria were as follows: UBM and/or AS-OCT was used; the study included corneal or conjunctival tumors; and the article was published in English, French, Dutch, or German. Results. There were 14 sources selected. Discussion. Several studies on the quality of AS-OCT and UBM show that these imaging techniques provide useful information about the internal features, extension, size, and shape of tumors. Yet there is no enough evidence on the advantages and disadvantages of UBM and AS-OCT in certain tumor types. Conclusion. More comparative studies are needed to investigate which imaging technique is most suitable for a certain tumor type.
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Applications of Anterior Segment Optical Coherence Tomography in Cornea and Ocular Surface Diseases. J Ophthalmol 2016; 2016:4971572. [PMID: 27721988 PMCID: PMC5046038 DOI: 10.1155/2016/4971572] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/31/2016] [Indexed: 11/29/2022] Open
Abstract
Optical coherence tomography (OCT) is a noncontact technology that produces high-resolution cross-sectional images of ocular tissues. Anterior segment OCT (AS-OCT) enables the precise visualization of anterior segment structure; thus, it can be used in various corneal and ocular surface disorders. In this review, the authors will discuss the application of AS-OCT for diagnosis and management of various corneal and ocular surface disorders. Use of AS-OCT for anterior segment surgery and postoperative management will also be discussed. In addition, application of the device for research using human data and animal models will be introduced.
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Haldar S, Leyland M. Spontaneous regression of a conjunctival naevus. BMJ Case Rep 2016; 2016:bcr-2016-216066. [PMID: 27581234 DOI: 10.1136/bcr-2016-216066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Conjunctival naevi are one of the most common lesions affecting the conjunctiva. While benign in the vast majority of cases, the risk of malignant transformation necessitates regular follow-up. They are well known to increase in size; however, we present the first photo-documented case of spontaneous regression of conjunctival naevus. In most cases, surgical excision is performed due to the clinician's concerns over malignancy. However, a substantial proportion of patients request excision. Highlighting the potential for regression of the lesion is important to ensure patients make an informed decision when contemplating such surgery.
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Affiliation(s)
- Shreya Haldar
- Department of Ophthalmology, John Radcliffe Hospital, Oxford, UK
| | - Martin Leyland
- Department of Ophthalmology, John Radcliffe Hospital, Oxford, UK
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Comparing Gonioscopy With Visante and Cirrus Optical Coherence Tomography for Anterior Chamber Angle Assessment in Glaucoma Patients. J Glaucoma 2016; 25:177-83. [PMID: 24844543 DOI: 10.1097/ijg.0000000000000076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare gonioscopy with Visante and Cirrus optical coherence tomography (OCT) for identifying angle structures and the presence of angle closure in patients with glaucoma. A secondary objective was to assess interrater agreement for gonioscopy grading among 3 independent examiners. METHODS Gonioscopy grading using Spaeth Classification and determination of angle-closure risk was performed on 1 randomly selected eye for 50 phakic patients. Images of the same eye using both Visante and Cirrus OCT were obtained in both light and dark conditions. Agreement of angle closure among 3 devices and interrater agreement for gonioscopy were determined using Cohen's κ (K) or Kendall's coefficient of concordance (W). RESULTS Of the 50 patients, 60% were female, 64% were white, and the mean age was 62 years. Angle closure was detected in 18%, 16%, and 48% of quadrants with Visante, Cirrus, and gonioscopy, respectively. The scleral spur was identified in 56% and 50% of quadrants with Visante and Cirrus OCT, respectively. Visante and Cirrus OCT showed moderate agreement in detecting angle closure (K=0.42 light, K=0.53 dark) but slight-to-fair agreement with gonioscopy (Visante K=0.25, Cirrus K=0.15). Gonioscopy demonstrated substantial agreement in angle closure (K=0.65 to 0.68) and angle-closure risk assessment (W=0.83) among 3 examiners. CONCLUSIONS Visante and Cirrus OCT imaging may have limited ability to identify angle closure because of difficulty identifying angle structures. Gonioscopy by well-trained clinicians had remarkably consistent agreement for identifying angle-closure risk.
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Alzahrani YA, Kumar S, Abdul Aziz H, Plesec T, Singh AD. Primary Acquired Melanosis: Clinical, Histopathologic and Optical Coherence Tomographic Correlation. Ocul Oncol Pathol 2015; 2:123-7. [PMID: 27390743 DOI: 10.1159/000440960] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/01/2015] [Indexed: 11/19/2022] Open
Abstract
AIM To assess the use of anterior segment optical coherence tomography (OCT) as an adjuvant diagnostic tool in primary acquired melanosis (PAM) by correlating clinical, histopathologic and anterior segment OCT findings. METHODS Twenty-four patients (24 eyes) with PAM of the conjunctiva, cornea or both were imaged with an anterior segment OCT device (RTVue, model-RT100; Optovue Inc., Fremont, Calif., USA). RESULTS Histopathologic diagnosis following excisional or incisional biopsy was confirmed in 13 out of 24 patients (54.6%). OCT images showed a characteristic uniformly thick basal epithelial hyperreflective band (about 20 μm thick) and normal thickness of the overlying epithelial layer in all patients (100%). The hyperreflective band on OCT correlated with the basal epithelial melanocytic pigmentation noted on histopathologic examination but did not vary in thickness between cases with or without atypia. CONCLUSIONS The characteristic basal epithelial hyperreflective band with normal overlying epithelium in the absence of cysts observed in all cases by anterior segment OCT correlated with clinical and histopathologic features of conjunctival and corneal PAM. Anterior segment OCT may be helpful as a noninvasive diagnostic tool for PAM. Improvement in resolution is necessary to detect melanocytic hyperplasia and aytpia suggestive of malignant potential.
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Affiliation(s)
- Yahya A Alzahrani
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Smita Kumar
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Hassan Abdul Aziz
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Thomas Plesec
- Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, Ohio, USA
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Nanji AA, Sayyad FE, Galor A, Dubovy S, Karp CL. High-Resolution Optical Coherence Tomography as an Adjunctive Tool in the Diagnosis of Corneal and Conjunctival Pathology. Ocul Surf 2015; 13:226-35. [PMID: 26045235 DOI: 10.1016/j.jtos.2015.02.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/01/2015] [Accepted: 02/01/2015] [Indexed: 11/24/2022]
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 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 was 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 noninvasive adjunctive tool in the diagnosis of ocular surface lesions.
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Affiliation(s)
- Afshan A Nanji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Fouad E Sayyad
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Miami Veteran Affairs Medical Center, Miami, FL, USA
| | - Sander Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
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Demirci H, Steen DW. Limitations in imaging common conjunctival and corneal pathologies with fourier-domain optical coherence tomography. Middle East Afr J Ophthalmol 2014; 21:220-4. [PMID: 25100905 PMCID: PMC4123273 DOI: 10.4103/0974-9233.134673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe the limitations of Fourier-domain optical coherence tomography (OCT) in imaging common conjunctival and corneal pathology. Materials and Methods: Retrospective, single-center case series of 40 patients with conjunctival and cornea pathology. Results: Fourier-domain OCT imaged laser in situ keratomileusis (LASIK) flaps in detail, including its relation to other corneal structures and abnormalities. Similarly, in infectious or degenerative corneal disorders, Fourier-domain OCT successfully showed the extent of infiltration or material deposition, which appeared as hyper-reflective areas. In cases with pterygium, the underlying cornea could not be imaged. All cases of common conjunctival pathologies, such as nevus or pinguecula, were successfully imaged in detail. Nevi, scleritis, pterygium, pinguecula, and subconjunctival hemorrhage were hyper-reflective lesions, while cysts and lymphangiectasia were hyporeflective. The details of the underlying sclera were not uniformly imaged in conjunctival pathologies. Fourier-domain OCT imaged the trabeculectomy bleb in detail, whereas the details of structures of the anterior chamber angle were not routinely visualized in all cases. Conclusions: Light scatter through vascularized, densely inflamed, or thick lesions limits the imaging capabilities of Fourier-domain anterior segment OCT.
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Affiliation(s)
- Hakan Demirci
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, USA
| | - Daniel W Steen
- Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan, USA
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Abstract
Optical coherence tomography (OCT) has become pivotal in the practice of ophthalmology. Similar to other ophthalmic subspecialties, ophthalmic oncology has also incorporated OCT into practice. Anterior segment OCT (AS-OCT), ultra-high resolution OCT (UHR-OCT), spectral domain OCT (SD-OCT) and enhanced depth imaging OCT (EDI-OCT), have all been described to be helpful in the diagnosis, treatment planning and monitoring response of ocular and periocular tumours. Herein we discuss the role of OCT including the advantages and limitations of its use in the setting of common intraocular and adnexal tumours.
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Affiliation(s)
- Carlos A Medina
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Plesec
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kim SK, Choi HJ, Kim MK, Wee WR. A Case of Giant Conjunctival Nevus Mimicking Malignant Melanoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.1.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sa Kang Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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Diagnosis of ocular surface lesions using ultra-high-resolution optical coherence tomography. Ophthalmology 2013; 120:883-91. [PMID: 23347984 DOI: 10.1016/j.ophtha.2012.10.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 10/15/2012] [Accepted: 10/18/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess the use of ultra-high-resolution (UHR) optical coherence tomography (OCT) in the diagnosis of ocular surface lesions. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS Fifty-four eyes of 53 consecutive patients with biopsy-proven ocular surface lesions: 8 primary acquired melanosis lesions, 5 amelanotic melanoma lesions, 2 nevi, 19 ocular surface squamous neoplasia lesions, 1 histiocytosis lesion, 6 conjunctival lymphoma lesions, 2 conjunctival amyloidosis lesions, and 11 pterygia lesions. INTERVENTION Ultra-high-resolution OCT imaging of the ocular surface lesions. MAIN OUTCOME MEASURES Clinical course and photographs, UHR OCT image, and histopathologic findings. RESULTS Ultra-high-resolution OCT images of all examined ocular surface lesions showed close correlation with the obtained histopathologic specimens. When clinical differential diagnosis of ocular surface lesions was broad, UHR OCT images provided optical signs indicating a more specific diagnosis and management. In cases of amelanotic melanoma, conjunctival amyloidosis, and primary histiocytosis and in 1 case of ocular surface squamous neoplasia, UHR OCT was instrumental in guiding the diagnosis. In those cases, UHR OCT suggested that the presumed clinical diagnosis was incorrect and favored a diagnosis that later was confirmed by histopathologic examination. CONCLUSIONS Correlations between UHR OCT and histopathologic findings confirm that UHR OCT is an adjunctive diagnostic method that can provide a noninvasive means to help guide diagnosis and management of ocular surface lesions. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Abstract
Pigmented conjunctival lesions primarily include melanoma, nevus, primary acquired melanosis (PAM), and complexion-associated melanosis. The incidence of conjunctival malignant melanoma (CMM) has significantly increased in the USA and Europe over the years, and it carries a very serious risk for metastasis and melanoma-related death. Conjunctival melanoma can arise de novo or from precursor lesions, nevus, and PAM. PAM is histologically separated into two distinct forms: PAM with atypia and without atypia. PAM with severe atypia progresses to malignant melanoma in up to 50% of cases and PAM without atypia virtually never progresses. Nevus is a benign melanocytic tumor that only rarely undergoes malignant transformation. Complexion-associated melanosis is frequently seen in more darkly pigmented individuals and does not progress to melanoma, although it can become very large. A detailed literature review on the various pigmented conjunctival lesions together with a schematic approach to diagnosis and management is presented.
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Affiliation(s)
- Patrick Oellers
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Kheirkhah A, Adelpour M, Nikdel M, Ghaffari R, Ghassemi H, Hashemi H. Evaluation of Conjunctival Graft Thickness after Pterygium Surgery by Anterior Segment Optical Coherence Tomography. Curr Eye Res 2011; 36:782-6. [DOI: 10.3109/02713683.2011.587937] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bianciotto C, Shields CL, Guzman JM, Romanelli-Gobbi M, Mazzuca D, Green WR, Shields JA. Assessment of anterior segment tumors with ultrasound biomicroscopy versus anterior segment optical coherence tomography in 200 cases. Ophthalmology 2011; 118:1297-302. [PMID: 21377736 DOI: 10.1016/j.ophtha.2010.11.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 10/29/2010] [Accepted: 11/09/2010] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare ultrasound biomicroscopy (UBM) versus anterior segment optical coherence tomography (AS-OCT) for imaging of tumors of the anterior segment of the eye. DESIGN Retrospective, noninterventional case series. PARTICIPANTS We included 200 patients. METHODS Review of medical records of patients who underwent both UBM and AS-OCT for evaluation of anterior segment tumors. MAIN OUTCOME MEASURES Comparison of tumor surface and internal visualization. RESULTS There were 200 eyes with anterior segment tumors involving the iris stroma in 96 (48%), ciliary body in 14 (7%), combined iris and ciliary body in 32 (16%), iris pigment epithelium (IPE) in 44 (22%), conjunctiva in 6 (3%), sclera in 4 (2%), and others in 6 (1% each). The diagnoses included nevus in 75 eyes (38%), melanoma in 47 (24%), cyst in 48 (24%), epithelioma (adenoma) in 5 (3%), metastasis, melanocytosis and melanocytoma in 4 eyes each (2%), and others (1% each). Image analysis (UBM vs AS-OCT) revealed adequate visualization of all tumor margins (189 [95%] vs 80 [40%]), posterior tumor shadowing (9 [5%] vs 144 [72%]), and high overall image quality (159 [80%] vs 136 [68%]). Comparison for better image resolution (UBM vs AS-OCT) disclosed UBM provided better overall tumor visualization (138 [69%] vs 62 [31%]) and better resolution of the posterior margin (147 [74%] vs 53 [27%]), whereas AS-OCT provided better resolution of the anterior margin (40 [20%] vs 160 [80%]) as well as better overall resolution of anterior segment anatomy (41 [21%] vs 159 [80%]). Better resolution was found with UBM for pigmented tumors (n = 162; 107 [66%] vs 55 [34%]) as well as for nonpigmented tumors (n = 38; 23 [61%] vs 15 [39%]). Regarding location, iris tumor resolution was similar with each technique (49 [52%] vs 45 [48%]). CONCLUSIONS For anterior segment tumors, UBM offers better visualization of the posterior margin and provides overall better images for entire tumor configuration compared with AS-OCT.
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Affiliation(s)
- Carlos Bianciotto
- Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA
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