Utility of high-resolution anterior segment optical coherence tomography in the diagnosis and management of sub-clinical ocular surface squamous neoplasia

Background:To evaluate the frequency and characteristics of sub-clinical ocular surface squamous neoplasia(OSSN)detected by high-resolution anterior segment tomography(HR-OCT)in patients with clinically unapparent disease following topical treatment.Methods:A retrospective chart review of patients with OSSN identified through a pharmacy database at the Bascom Palmer Eye Institute from January 2013 to December 2018 was conducted.Patients undergoing primary therapy with topical 5-fluorouracil 1%(5-FU)(4 times a day for 7 days with a 21-day break)or interferon-alpha-2b(IFN)(4 times a day)were reviewed.Patients were separated into two groups.Group 1 included individuals whose clinical resolution of OSSN aligned with complete resolution on HR-OCT.Group 2(sub-clinical OSSN group)included individuals with clinical OSSN resolution but with features of persistent disease on HR-OCT.Patients excluded included those treated at an outside institution and those who used topical therapy as a surgical adjunct.Results:A total of 95 patients(95 eyes)were reviewed.Sub-clinical OSSN was detected at a frequency of 17%in our study patients(n=16 patients,9 treated with 5-FU and 7 treated with IFN).In the 16 individuals,the mean time to clinical resolution was 3.6±1.0 cycles for 5-FU and 4.0±0.0 months for IFN.An additional 2.1±0.8 cycles for 5-FU and 1.2±0.4 months for IFN were needed to achieve HR-OCT resolution of OSSN.Recurrence in Group 1 was noted in 10 patients(12%)while no recurrences occurred in Group 2,the cohort with subclinical disease that received the extended medical therapy.The mean follow-up was 24.0±17.9 months.Conclusion:We found that at least 17%of individuals with apparent clinical resolution of OSSN have sub-clinical disease detected on HR-OCT.This information can be used to optimize treatment and extend therapy past the point of clinical resolution.

Current applications of machine learning in the screening and diagnosis of glaucoma: a systematic review and Meta-analysis

AIM: To compare the effectiveness of two well described machine learning modalities, ocular coherence tomography(OCT) and fundal photography, in terms of diagnostic accuracy in the screening and diagnosis of glaucoma. METHODS: A systematic search of Embase and Pub Med databases was undertaken up to 1 st of February 2019. Articles were identified alongside their reference lists and relevant studies were aggregated. A Meta-analysis of diagnostic accuracy in terms of area under the receiver operating curve(AUROC) was performed. For the studies which did not report an AUROC, reported sensitivity and specificity values were combined to create a summary ROC curve which was included in the Meta-analysis.RESULTS: A total of 23 studies were deemed suitable for inclusion in the Meta-analysis. This included 10 papers from the OCT cohort and 13 from the fundal photos cohort. Random effects Meta-analysis gave a pooled AUROC of 0.957(95%CI=0.917 to 0.997) for fundal photos and 0.923(95%CI=0.889 to 0.957) for the OCT cohort. The slightly higher accuracy of fundal photos methods is likely attributable to the much larger database of images used to train the models(59 788 vs 1743). CONCLUSION: No demonstrable difference is shown between the diagnostic accuracy of the two modalities. The ease of access and lower cost associated with fundal photo acquisition make that the more appealing option in terms of screening on a global scale, however further studies need to be undertaken, owing largely to the poor study quality associated with the fundal photography cohort.

Rare giant corneal keloid presenting 26 years after trauma:A case report

BACKGROUND Corneal keloid is a rare clinical disease with an unknown etiology,which is easily misdiagnosed.Surgery is the most effective treatment but is rarely reported in the literature.Herein,we report the clinical features,histopathology,and surgical outcome of a giant corneal keloid with trophoblastic vessels and discuss the genesis of the mass.CASE SUMMARY A 36-year-old young man was admitted to the hospital because of a large mass on the surface of the left cornea.The patient had suffered an injury to his left eye at the age of 6-years-old;however,as the injury did not cause cornea perforation,he did not undergo treatment.Slit lamp exam showed a large,elevated,opaque lesion that covered the entire cornea and protruded from the surface of the eyeball.Anterior segment optical coherence tomography(AS-OCT) revealed a lesion of irregular density involving the anterior stroma.We suspected a secondary corneal fibroproliferative mass based on the clinical history,and slit lamp and AS-OCT findings.The patient subsequently underwent a superficial keratectomy and keratoplasty,and the final diagnosis of corneal keloid was confirmed by intraoperative histopathological examination.CONCLUSION Non-penetrating corneal trauma damages corneal epithelium basement membrane,initiating stromal fibrosis and causing corneal keloids.AS-OCT and biopsy confirm diagnosis.