slit lamp examination to diagnose clinical features of ocular surface squamous neoplasia

使用眼前节 HR-OCT 评估眼表鳞状瘤变

Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented tumor of the conjunctiva and cornea. The term OSSN encompasses a broad spectrum of squamous neoplastic changes, including dysplasia (graded I-III), intraepithelial neoplasia (i.e., carcinoma in situ, CIS), and invasive squamous cell carcinoma (SCC)1. The diagnosis of OSSN can be made clinically by slit lamp examination by detecting the typical appearance of elevated, leukoplakic or papilliform mass, often presented at limbus straddling conjunctiva to the cornea with feeder vessels2. Sometimes, they may present less distinctively. The gold standard for the diagnosis of OSSN remains histopathologic confirmation followed by incisional or excisional biopsy1,3. 
Recently, the therapeutic pattern of OSSN has shifted from surgical management to the use of topical chemotherapy. This has greatly promoted the adoption of biopsy to less or non-invasive modalities4. Various imaging devices have been studied for the characterization of OSSN, namely HR-OCT, in vivo confocal microscopy (IVCM)5, impression cytology (IC)6, ultrasound biomicroscopy (UBM)7, and methylene blue stain4. Currently, several studies have provided insights into the characterization of OSSN using anterior segment HR-OCT. Commercially available HR-OCT devices using spectral-domain technology can attain an axial resolution of approximately 5 &#181;m. These images provide in vivo, cross-sectional views of ocular surface lesions and display distinct features of OSSN that parallel the changes seen in histopathology. Hence, HR-OCT enables clinicians to obtain an "optical biopsy" to expediently diagnose and monitor OSSN in clinics.
To promote the application of HR-OCT in the management of OSSN, a standardized, practical, and reproducible guidance for image acquisition is presented in detail to ensure good quality for clinical use. Also, characteristics of OSSN and other common benign lesions on HR-OCT are elucidated for better image interpretation.

作者聚焦： 前部 HR-OCT 作为表征眼表鳞状瘤变的非侵入性工具

前路高分辨率光学相干断层扫描在眼表鳞状瘤变诊断和治疗监测中的应用

And here, a high resolution optical coherence tomography, or HROCT, is a promising tool for non-invasively characterizing ocular surface screen errors, neoplasia, or OSSN. It provides an in-vivo transsectional volume of ocular surface lesions, offering an optical biopsy. For OSSN, we presented a standardized, practical, reproducible approach to assist clinicians in managing OSSN in clinical workflows.HROCT can expandedly assist in guiding the differentiation of OSSN from various ocular lesions. HROCT images of OSSN displaying three distinct features:hyper reflective epithelial thickening, a rapid transition from normal epithelium to abnormal tissue, and a distinct claim between the lesion and underlying tissues. Most non-epithelial derived diseases purely present as normal epithelium with thickening subepithelial lesions.The imaging biomarkers in a HROCT of OSSN can be extended further in deep learning applications. This can help ophthalmologists increase their diagnostic, prognostic, and monitoring accuracy, as well as decrease workloads and costs.

裂隙灯检查诊断眼表鳞状瘤变的临床特征

slit-lamp-examination-to-diagnose-clinical-features-ocular-surface

Research

JoVE Journal

Engineering

Slit Lamp Examination to Diagnose Clinical Features of Ocular Surface Squamous Neoplasia

129 次观看. 要开始检查，请受试者坐在裂隙灯后面，并向受试者解释测试程序。编辑主题的信息。用酒精棉签擦拭裂隙灯头和下巴托，对装置进行消毒。要定位要检查的对象，请将他们的下巴放在下巴托上。让受试者旋转眼球以充分暴露病灶，并在裂隙灯下观察病灶。然后使用裂隙灯进行眼前节摄影以记录临床特征。翻转眼睑，观察睑结膜或睑结膜?...

视频: 裂隙灯检查诊断眼表鳞状瘤变的临床特征

Anterior High-Resolution Optical Coherence Tomography in the Diagnosis and Therapeutic Monitoring of Ocular Surface Squamous Neoplasia

Ocular surface squamous neoplasia (OSSN) is the most common tumor of the ocular surface, ranging from mild dysplasia to invasive squamous carcinoma. Traditionally, the diagnosis of OSSN relies on histopathological confirmation followed by a full-thickness biopsy. However, in the past two decades, the therapeutic approach to OSSN has shifted from surgical intervention to topical chemotherapy regimens in clinical settings. This shift emphasizes the need for less invasive or non-invasive methods to diagnose ocular surface pathologies. Among various imaging devices, commercially available high-resolution optical coherence tomography (HR-OCT) has emerged as a powerful tool for the characterization of OSSN. HR-OCT provides an in vivo, cross-sectional view of ocular surface lesions, offering an "optical biopsy" for OSSN with high sensitivity and specificity. It provides valuable information in differentiating intraepithelial or invasive OSSN from other benign lesions. Additionally, HR-OCT can be used to monitor the response to topical chemotherapy and to detect subclinical OSSN during follow-up visits. In this article, the scanning protocol for image acquisition is presented, and image interpretation for OSSN is outlined. This standardized, practical, and reproducible approach is recommended in clinical workflows and is expected to assist clinicians in the management of OSSN.

Anterior segment high-resolution optical coherence tomography (HR-OCT) is a promising non-invasive modality for the diagnosis and therapeutic evaluation of ocular surface squamous neoplasia (OSSN). Here, the system setup, scanning technique, and representative diagnostic results are presented.

Ocular surface squamous neoplasia (OSSN) is the most common tumor of the ocular surface, ranging from mild dysplasia to invasive squamous carcinoma. ...

科研

工程学

To begin the examination, ask the subject to sit behind the slit lamp and explain the testing procedures to the subject. Edit the subject's information. Disinfect the setup by wiping down the slit lamp head and chin rest with an alcohol swab.To position the subject for examination, place their chin on the chin rest. Ask the subject to rotate the eyeball to fully expose the lesion and observe the lesion under the slit lamp. Then perform anterior segment photography with the slit lamp to document clinical features.Flip the eyelids to observe whether forniceal or palpebral conjunctiva are affected. Note all the listed details of the lesion during the clinical examination.

Acquiring Anterior Segment High-Resolution Optical Coherence Tomography Images for Therapeutic Evaluation of Ocular Surface Squamous Neoplasia

Ask the subject to sit behind the imaging device, and explain the testing procedures to the subject. Then, double click on the RTView icon to start the procedure. Click on the new patient button to create a new patient and fill out the information fields, such as last name, first name, gender, birth date, and ethnicity.Click on the save button. Now, disinfect the setup by wiping down the OCT head and chin rest with an alcohol swab. Select the desired scan pattern by clicking on the cross line, followed by the cornea button.Attach the anterior segment lens to the system scanner. Then, select the eye to be scanned according to the anterior segment slit lamp photography. Ask the subject to place their chin on the chin rest, and instruct the subject to roll the eyeball to fully expose the ocular surface lesion.Align the lesion of interest with the center of the scan. Click on the scan tab. Afterward, press Auto P to enhance signal strength.Adjust the scanner head to get the best ocular image. Capture the image using the eight millimeters by eight millimeters automated segmentation OCT scan. Review the OCT slices before saving the scan.To determine the region of interest, observe the dynamic sectional view during alignment, align the cross line with the thickest point of the lesion, and capture the scan. Pay attention to the adjacent parts of normal and abnormal tissue. Capture the border of the lesion.Open the system software, and locate the existing patient by typing their name or birth date in the search by space. Input the patient's relevant information, and click on the search button. Once the patient is located, click on their name to list all the visits.Choose the latest visit and review the OCT images. Click on the scan button to obtain the current AS-OCT image as demonstrated previously, and assess the parameters.

获取眼前节高分辨率光学相干断层扫描图像用于眼表鳞状瘤变的治疗评估

Optical Coherence Tomography Image Analysis for Therapeutic Evaluation of Ocular Surface Squamous Neoplasia 

To begin the Optical Coherence Tomography, or OCT image analysis, open the system software. Navigate to the measuring tool section, and click on the View B-Scans icon. Then within the measuring tools, select the Distance tool to measure the maximal epithelial and subepithelial thickness values of the lesion.Do so by choosing an initial point on the anterior epithelium boundary. Then move vertically to the visible separation between the epithelial and subepithelial layers. Save the maximal area measurement data as Epithelial Thickness.Next, select an anchor point on the visible separation between the epithelial and subepithelial layers, and proceed vertically to the posterior border of the lesion, which is typically the anterior boundary of the sclera. Save the maximal area measurement data as Subepithelial Thickness. Utilizing the Snapshot Tool icon, export a JPG image of the measurement report screen.