title: Diagnosis and management of conjunctival and corneal intraepithelial neoplasia using ultra high-resolution optical coherence tomography.
abstract: OBJECTIVE
  To report a novel diagnostic technique and a case series of conjunctival and corneal intraepithelial neoplasia (CCIN) diagnosed and followed up using prototype ultra high-resolution (UHR) optical coherence tomography (OCT).
  
  
  METHODS
  Prospective, noncomparative, interventional case series.
  
  
  METHODS
  Seven eyes of 7 consecutive patients with CCIN treated using topical interferon alfa-2b or 5-fluorouracil and 7 eyes of 6 consecutive patients with history of surgically excised pterygia.
  
  
  METHODS
  Ultra high-resolution OCT imaging of the ocular surface at primary diagnosis of CCIN and during the follow-up period until resolution of the lesion. Ultra high-resolution OCT images of sites of excised pterygia also were captured and compared with images from resolved CCIN patients.
  
  
  METHODS
  Clinical course and photographs, UHR OCT images, and histopathologic findings.
  
  
  RESULTS
  Ultra high-resolution OCT was capable of providing a noninvasive optical biopsy of all examined CCIN lesions. Ultra high-resolution OCT images of the lesions disclosed a thickened hyperreflective epithelium and abrupt transition from normal to hyperreflective epithelium in all 7 cases. Ultra high-resolution OCT images showed excellent correlation with histopathologic specimens obtained at primary diagnosis of the cases that had incisional biopsies before treatment. All patients were treated medically and were followed up for clinical resolution. In 4 patients, at clinical resolution, UHR OCT images also showed normal epithelial configuration at the site of the treated lesions. In 3 patients, despite apparent clinical resolution, the UHR OCT was able to detect residual disease that was clinically invisible. Continuation of treatment resulted in complete resolution of the residual lesions on the UHR OCT images in all cases. Ultra high-resolution OCT images of patients with surgically excised pterygia demonstrated similar findings to resolved CCIN cases.
  
  
  CONCLUSIONS
  Ultra high-resolution OCT is a novel noninvasive technique to diagnose and manage medically treated CCIN. Using UHR OCT to guide medical treatment could prevent the premature termination of topical treatment in the presence of subclinical disease. A larger sample size is needed for further validation of its sensitivity and specificity.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Mohamed Abou
authors.initials: MA
authors.lastname: Shousha
authors.forename: Carol L
authors.initials: CL
authors.lastname: Karp
authors.forename: Victor L
authors.initials: VL
authors.lastname: Perez
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Roberta
authors.initials: R
authors.lastname: Ventura
authors.forename: Victoria
authors.initials: V
authors.lastname: Chang
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.forename: Jianhua
authors.initials: J
authors.lastname: Wang
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000188:drug therapy; D003230:Conjunctival Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D003316:Corneal Diseases / Q000175:diagnosis* / Q000188:drug therapy; D005134:Eye Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011625:Pterygium / Q000601:surgery; D011994:Recombinant Proteins; D041623:Tomography, Optical Coherence / Q000379:methods*
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D005472:Fluorouracil