Optical coherence tomography angiography in the evaluation of vascular patterns of ocular surface squamous neoplasia during topical medical treatment.

PURPOSE: Optical coherence tomography angiography (OCTA) was utilized to examine changes in ocular surface squamous neoplasia (OSSN) vascular patterns over time in individuals treated with topical medical therapy. METHODS: Ten individuals with OSSN diagnosed by clinical examination and high resolution (HR)-optical coherence tomography (OCT) were recruited. All individuals received topical immuno- or chemotherapy. OCTA images were obtained and analyzed at three points: presentation, mid-treatment and tumor resolution. Tumor metrics including tumor area (TA), tumor volume (TV), tumor depth (TD), and total tumor density (TTD) were calculated. Vessel area density (VAD) was also quantified within the OSSN, the subepithelium under and adjacent to the OSSN and the subepithelium of the uninvolved, contralateral eye. Vascular network changes were also subjectively evaluated. RESULTS: TA, TV, TD and TTD all significantly decreased with time (p < 0.001). The mean VAD within the OSSN significantly decreased (p < 0.001) between visits (presentation: 26.52 ± 6.8%, mid-treatment: 7.19 ± 5.88%, tumor resolution: 0.11 ± 0.34%). The mean subepithelial VAD under the OSSN also decreased with time (23.22 ± 11.03%, 20.99 ± 5.99% and 19.58 ± 7.08%), and after resolution the sub-tumor VAD (19.58 ± 7.08%) was comparable to the subepithelial VAD in the contralateral eye (15.47 ± 4.37%, p > 0.05). The mean VAD in the subepithelium adjacent to the OSSN increased with treatment, then decreased significantly between mid-treatment and resolution (23.26 ± 4.54, 28.30 ± 7.43% and 21.68 ± 6.10%, p = 0.009). Qualitatively, the tumor subepithelial vascular network was complex and dense but with tumor resolution appeared less tortuous and similar to the uninvolved eye. CONCLUSION: OCTA provided insight into the pathophysiology of tumor angiogenesis, showing decreased vascular density and normalization of vascular networks associated with tumor resolution.

Role of optical coherence tomography angiography in the characterization of vascular network patterns of ocular surface squamous neoplasia.

PURPOSE: To visualize and quantify vascular networks in individuals with ocular surface squamous neoplasia (OSSN) through optical coherence tomography angiography (OCTA). METHOD: Cross-sectional study of OSSN patients. Vascular networks were measured by OCTA in the epithelium and sub-epithelial space in the tumors, adjacent tissue, and in the contralateral eye. Vessel area density (VAD, percent of blood vessels within 2.14 mm2), was calculated for each location. Total tumor density (TTD, percent of blood vessels within the entire tumor) was calculated. VAD was assessed separately for corneal and conjunctival locations and compared. RESULTS: Fifteen patients with OSSN were included. The mean age was 61 ±â€¯12 years and the majority were male (80%). The mean tumor area, volume, depth, and TTD were 28.0 ±â€¯9.0 mm2 (range, 10.9-39.7), 9.1 ±â€¯4.1 mm3 (range, 3.4-18.8), 334 ±â€¯125 µm (range, 177-571), and 33.2% ±â€¯11.0% (range, 18.7-58.8), respectively. The VAD was highest within the tumor (28.9% ±â€¯8.7%) followed by the adjacent sub-epithelial tissue and the tissue underneath the conjunctival component of tumor. These densities were higher than the VAD in the tissues of the non-involved eye (all P < 0.05). The VAD within conjunctival component of tumor was significantly higher than those with corneal component (29.8% ±â€¯9.5% vs. 21.1% ±â€¯5.5%, p = 0.006). The VAD under conjunctival tumor was also significantly higher than under corneal component (24.1% ±â€¯7.8% vs. 17.0% ±â€¯6.1%, p = 0.024). CONCLUSIONS: OCTA imaging allowed for visualization and quantification of vessel structure and density within, under, and surrounding OSSN.