Anterior High-Resolution OCT in the Diagnosis and Management of Corneal Squamous Hyperplasia Mimicking a Malignancy: a Case Report.

Abstract Background Anterior high-resolution optical coherence tomography (HR-OCT) is a novel non-invasive in vivo imaging modality that can assist in the diagnosis and management of various ophthalmic pathologies. The implementation of diagnosing ocular surface lesions has been explored in previous studies, successfully revealing specific signs in some ocular lesions. This case report aims to exhibit a case of corneal squamous hyperplasia diagnosed via anterior HR-OCT, prior to surgical intervention. Case presentation A 69 year-old male had blurred vision and foreign body sensation OD for several weeks. A rapidly-grown corneal mass was presented, showing an appearance of a grayish flesh-colored mass with elastic texture. Large vessels supplying the mass were also found. Anterior HR-OCT was performed, and the results suggested the lesion be benign hyperplasia. Superficial keratectomy was done, and the pathologic report showed mild-appearing epithelial squamous hyperplasia, which confirmed the analysis via anterior HR-OCT. Conclusion In the categorization by Nanji, et al. of corneal surface diseases using anterior OCT, the comparative epithelial thickness (normal range: 47—68 μm); inferior border obscuration of epithelium (normal or benign inferior border: no shadowing); reflectivity of epithelial layer (normal: not hyper-reflective); abrupt transition (normal: no horizontally abrupt transition); and sub-epithelium analysis vary between benign and malignant lesions (normal: demarcated anterior to Bowman’s layer), and the differences are systemically sorted. We applied all these characteristics to our patient as guidance, and the measurement results indicated the lesion be a benign lesion, which is consistent with the tissue pathology. Anterior HR-OCT is overall a non-invasive and timely method capable of assisting the diagnosis of ocular surface disease, predicting the qualities of a lesion, and determining the follow-up treatment plan.