Advancing wavelike epitheliopathy after conjunctival intraepithelial neoplasia. Atipical case report

An atypical Advancing Wavelike Epitheliopathy case, consecutive to topical treatment for a 360º Conjunctival Intraepithelial Neoplasia, is presented. Mitomycin (0.2 mg/mL) and interferon (1 MUI/mL) drops were used. An atypical presentation, with migrating limbal focus, non clearly delimited in its hourly site through its evolution. Treated with flurometholone drops plus artificial tears, working to complete resolution.

High resolution anterior segment optical coherence tomography for differential diagnosis between corneo-conjunctival intraepithelial neoplasia and pterygium

OBJECTIVE

To assess if anterior segment optical coherence tomography (AS-OCT) is a noninvasive diagnostic method suitable to differentiate benign corneo-conjunctival lesions (pterygium) from premalignant lesions (corneo-conjunctival intraepithelial neoplasia, CIN).

MATERIAL AND METHODS

An observational, analytical and cross-sectional study was conducted in 22 eyes with conjunctival lesions clinically suspicious for pterygium and CIN during two years. Morphological differences between both lesions were studied with AS-OCT; epithelial thicknesses (EE) and extension length on corneal surface (GIC) were compared between both groups. A surgical excision of the lesion was performed for histopathological diagnosis.

RESULTS

Mean age of patients with pterygium (n=18) was 52.67±15 y.o and 74±12 y.o in subjects with CIN (n=4) (p<0.021). In pterygia, AS-OCT showed typical features (normal, thinning or slightly thickened EE; 77.4±26μm), in addition to an increase in wedge-shaped subepithelial tissue. Patients with CIN had a mean thickened EE (262.5±124μm) and strongly hyperreflective, with abrupt transition between normal and pathological epithelium. Analysis of EE between subjects with pterygium and CIN revealed statistically significant differences (p<0.002). ROC curve revealed a 100% sensitivity and specificity of OCT-SA in differentiation between CIN and pterygium, using 141μm as cutoff point of EE.

CONCLUSION

AS-OCT is a useful tool for the differentiation between pterygium and CIN able to provide typical morphological characteristics. An EE greater than 141μm in AS-OCT suggests a sensitivity and specificity of 100% for the diagnosis of CIN.