Analysis of Ocular Surface Tumours and Lesions by High-definition Anterior-segment Optical Coherence Tomography

High resolution AS-OCT (Anterior segment- Optical coherence tomography) is an imaging modality predominantly used in tertiary ophthalmologic centres to diagnose and characterise various ocular surface tumours as well as an adjunct to monitor treatment response.

The objective of this study was to evaluate the utility of AS-OCT for ocular surface tumours.

This was a prospective cohort study of patients done at a tertiary care hospital in Nepal over one year from 2023 August to 2024 July. A consecutive sampling was done in the patients aged 18 years and older who were suspected of having ocular surface tumours and lesions during the study period. Demographic data, slit lamp biomicroscopic examination including size, site and morphology of tumour and AS-OCT using High Definition Zeiss Cirrus 6000 were carried out for all patients enrolled. Diagnosis was based on clinical evaluation and AS-OCT features. Those patients suspected of malignancy surgical excision and their histopathology was analysed.

Among the 110 enrolled patients, the median age was 50 (range: 18-87) years. Of them, 63 (57%) were female and 47 (43%) were male. A total of 5 (4.5%) participants had bilateral involvement. Based on clinical picture and AS-OCT features, 84 eyes (73.04%) were diagnosed to have ocular surface squamous neoplasia (OSSN), 18 eyes (15.65%) with conjunctival nevus and two eyes (1.73%) were suspected to have melanoma. Histopathology of 80 eyes who underwent surgical excision, OSSN of various grades in 86% eyes was the most common diagnosis followed by conjunctival melanoma in 3%.

Though HPE is a gold standard for diagnosing ocular surface tumours, AS-OCT can provide a noninvasive optical biopsy. Additional research in AS-OCT is needed to increase the sensitivity and specificity of accurately diagnosing ocular surface lesions.