Use of High-Resolution Optical Coherence Tomography in the Surgical Management of Ocular Surface Squamous Neoplasia: A Pilot Study.

Abstract

PURPOSE\nTo evaluate whether high-resolution optical coherence tomography (HR-OCT) can detect histologic tumor margins of ocular surface squamous neoplasia (OSSN).\n\n\nMETHODS\nEight eyes of 8 patients with OSSN undergoing excision were studied prospectively. Immediately before surgery, the tumor was imaged using a commercially available HR-OCT (Bioptigen/Leica Microsystems, Buffalo Grove, IL) to identify the conjunctival margins of the neoplastic lesion. The tumor borders of the lesion determined by HR-OCT were mapped in relation to an anatomical reference point and transferred intraoperatively. The tumor was excised with 4 mm margins from the visible edge of the lesion with a no-touch technique. The specimens were sent for pathological analysis and the histologic tumor margin was compared to the HR-OCT predicted tumor border.\n\n\nRESULTS\nMean age of the 8 patients were 67+ 9.9 years. Seven (87.5%) were male, 7(87.5%) were white and ethnically, 3 (37.5%) were Hispanic. All eight tumors were bulbar and in the exposure zone. Seven tumors were limbal. Corneal extension was present in 5(62.5%). Mean tumor area was 17.5±11.1 mm2. Clinically, two (25%) of the tumors were leukoplakic, 1(12.5%) papillomatous, and 3(37.5%) gelatinous. A conjunctival tumor margin identified with the HR-OCT coincided with the pathologically confirmed margin mark in all eyes.\n\n\nCONCLUSIONS\nHR-OCT has the potential to predict histologic tumor margins in OSSN. Optical identification of tumor margins could potentially decrease the incidence of residual positive margins, and minimize healthy tissue removal. Advances in HR-OCT technology and integration into a microscope for real-time imaging are needed to further improve this technique.