May 31, 2019 Conference


Novel Assessment of Conjunctival Lesions Using Anterior Segment OCTA and En Face OCT Imaging

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Dr. Huan Mills, Tufts New England Eye Center (Presenter)
William Binotti, Tufts Medical Center
Ricardo Nose, Tufts New England Eye Center
Dr. Helen K. Wu, Tufts Medical Center
Dr. Pedram Hamrah, Tufts

Methods: We performed a retrospective review of patients with biopsy-confirmed OSL and used Avanti XR (Optovue Inc., Freemont, CA) AS-OCT, en face OCT, and AS-OCTA imaging to assess morphological features and vasculature of the lesion. Two masked graders performed measurements of total lesion thickness, epithelial thickness, area at OSL base, and vessel diameter and depth entering the OSL.

Results: A total of 20 eyes with OSL from 18 patients, with biopsy-confirmation in clinically suspected lesions, were analyzed (4 nevi, 5 pingueculae, 2 conjunctival intraepithelial neoplasias (CIN), 2 squamous cell carcinomas, 2 lymphomas and 2 melanomas). There was no statistical difference of age and gender between benign and malignant groups (p>0.05). We compared benign lesions such as nevi and pingueculae with malignant lesions such as conjunctival intraepithelial neoplasia, squamous cell carcinoma, lymphoma, and melanoma. Malignant lesions did not have a statistically significant difference in total lesion thickness or area when compared with benign lesions. The CIN and squamous cell carcinoma cases demonstrated a characteristic hyper-reflective and thickened epithelium. Malignant lesions had a statistically greater epithelial thickness of 82.2 ± 34 µm compared to benign lesions, which had an average epithelial thickness of 60.5 ± 20 µm (p=0.012).  Dilated feeder vessels were another hallmark feature that was readily visualized by AS-OCTA in malignant lesions. The identified malignant feeder vessels were larger in diameter measuring at 70.7 ± 20 µm compared to vessels found in benign lesions which measured 43.3 ± 9 µm (p=0.001). In addition, the vessel depth of malignant lesions were deeper at 336.9 ± 81 µm compared to vessels of benign lesions which had an average depth of 191.1 ± 38 µm (p<0.001).

Conclusion: Multimodal OCT imaging is non-invasive and could be a useful quantitative tool in the diagnosis and management of OSL.