International Medical Case Reports Journal (Nov 2019)
Anterior-Segment Optical Coherence Tomography–Guided Measurement Of A Melting Ulcer For Follow-Up Of Corneoscleral Thinning Progression
Abstract
Shai Cohen,1,2 Yisroel Tucker,3 Sharon Guttman,2,4 Ettel Bubis,2,3 Yair Rubinstein,3 Alon Skaat,2,5 Ifat Sher,2,3 Ygal Rotenstreich2,3 1Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel; 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel; 4Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel; 5Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, IsraelCorrespondence: Ygal RotenstreichGoldschleger Eye Institute, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, IsraelTel +972-3-5308132Email [email protected]: To evaluate the feasibility of using anterior-segment optical coherence tomography (AS-OCT) for three-dimensional assessment of corneoscleral thinning progression in ulcers after pterygium removal.Methods: A patient with corneoscleral melting after pterygium removal surgery and mitomycin C treatment was evaluated using AS-OCT imaging of the corneoscleral ulcer at five consecutive time points, up to 2 years. AS-OCT scans of 8.3×5.6 mm (15°×10°) containing 41 B-scans spaced 139 μm apart were performed monthly for 4 months and then at 2 years following pterygium removal. A single B-scan was comprised of 768 A-scans. Ten B-scans of the same position were averaged in a single AS-OCT image. The area of ulcer’s section (AUS) was measured in seven fixed landmarks through a horizontally aligned plane in order to provide an estimation of the three-dimensional size of the lesion.Results: The AUS in the two superior locations increased during the follow-up period to an average of 114% at 2 years compared to the initial visit. In the other five locations (three midline and two inferior), the AUS decreased and was on average 64% in the midline and 29% in the inferior locations at 24 months.Conclusion: AS-OCT provided a readily available assessment of the lesion’s three-dimensional size during repeated follow-ups and identification of localized areas at higher risk for perforation. This method may potentially be useful for corneal surface pathologies requiring repeated follow-ups and may aid in decision-making regarding corneal thickness based on an accurate measurement.Keywords: anterior segment optical coherence tomography, corneoscleral melt, pterygium, corneoscleral thinning, ulcer follow up
