Comparison of ocular surface squamous neoplasia and pterygium using anterior segment optical coherence tomography angiography

PURPOSE: To compare ocular surface squamous neoplasia (OSSN) and pterygium using anterior segment optical coherence tomography angiography (AS-OCTA). OBSERVATIONS: Flow patterns of conjunctival vessels in patients with OSSN and pterygium were investigated using AS-OCTA. In case 1, slit-lamp examination of a 72-year-old woman revealed an elevated lesion with increased permeability of fluorescein in the inferior nasal conjunctiva of her left eye. AS-OCTA showed markedly meandering large blood vessels in both the superficial and deep layers. Histopathological evaluation of the conjunctival biopsy indicated conjunctival intraepithelial neoplasia. Case 2 was that of a 79-year-old man with a history of three conjunctival tumor excisions. Slit-lamp examination showed an elevated lesion with hyperpermeability of fluorescein in the nasal conjunctiva of his left eye. AS-OCTA revealed increased meandering vasculature in both the superficial and deep layers. Histopathological investigation concluded that the diagnosis was squamous cell carcinoma. Case 3 involved a 61-year-old man with a pterygium. Slit-lamp examination showed typical findings of an elevated nasal lesion accompanied by a head that appeared triangular with a blunt apex. AS-OCTA revealed increased straight vasculature in the superficial layer and an avascular area in the deep layer of the pterygium head. CONCLUSIONS AND IMPORTANCE: AS-OCTA revealed abnormal “zigzag vessel patterns” in both the superficial and deep layers denoting meandering vessels in the patients with OSSN. In the patient with the pterygium, it showed “straight vessel patterns” signifying unbending stretched vessels in the superficial layer and an avascular zone in the deep layer of the pterygium head. These findings may be useful for the differential diagnosis of OSSN and pterygium.