Granular corneal dystrophy treated with deep anterior lamellar keratoplasty: comparing histological analysis and optical coherence tomography

Granular corneal dystrophy is a rare autosomal dominant disease. It is characterized by breadcrumb-like granular opacities in the central corneal stroma. The mutation has been localized in the TGFβI gene, which codes for keratoepithelin, an adhesion protein found in corneal epithelium and stroma. We report the case of granular corneal dystrophy in a 60-year-old man complaining of reduced visual acuity. Slit-lamp examination revealed multiple opacities in the central stroma of his left eye, and recurrent deposits in his other eye 13?years after penetrating keratoplasty. An anterior segment optical coherence tomography (Visante(?) OCT) was used to determine the location of deposits, then a deep anterior lamellar keratoplasty was performed in his left eye. The depth of the deposits revealed by Visante(?) OCT correlated well with the postsurgical histological findings. Visante(?) OCT can therefore help choose between phototherapeutic keratectomy and lamellar keratoplasty, techniques that are less invasive than penetrating keratoplasty, which is advantageous since this dystrophy is known to recur after surgery.     

Histopathological correlation of corneal diseases with optical coherence tomography

PURPOSE: To correlate the cross-sectional images of corneal diseases obtained by optical coherence tomography (OCT) with light microscopy (LM) to determine the corneal components represented in OCT images. METHODS: In a prospective comparative tissue study clinicopathological correlations of six patients with pseudophakic bullous keratopathy ( n=3), advanced keratoconus ( n=1), persistent epithelial defect with corneal thinning ( n=1), and retrocorneal membrane ( n=1) were included. Immediately before a planned penetrating keratoplasty (PKP) noncontact slitlamp-adapted OCT of the cornea was performed. After PKP and following standard histological processing the specimens were examined under LM to compare qualitatively the morphology, and quantitatively the morphometry at selected corneal locations. RESULTS: The cross-sectional optical-reflectivity profiles enabled the reproducible morphological evaluation of the corneal structures and changes. Layers of relative high reflectivity corresponded to the anterior corneal surface and internal stromal layers. In contrast, the deeper corneal epithelial layer demonstrated relative low reflectivity by OCT. An increase in light reflectivity corresponded to corneal scarring, irregularities of the corneal lamellae, and deposition of basal membrane material. Low signal intensity was particularly due to fluid accumulations and shadowing. The most prominent changes were caused by corneal scars or edematous tissue. The morphometric analysis with OCT revealed, in this study, thickness measurements ranging from 31 to 902 micro m. Although the mean OCT thickness values were up to 9% ( P=0.014) higher than those derived from LM, there was a significant positive correlation (r=0.94; P<0.001) between corneal OCT and the light-microscopic measurements. CONCLUSION: Noncontact slitlamp-adapted corneal OCT revealed a good correlation with histological sections. The differences noted were partly related to shrinking processes during preparation. Thus, with certain limitations, OCT allows a non-invasive optical biopsy of pathological structures in corneal diseases.     

OCT3 exploration of anterior segment

PURPOSE: Posterior pole imaging with OCT3 provides macular scans with a very high resolution. Use of OCT1 has already been described for anterior segment imaging. This work presents the advantages of OCT3 in anterior segment imaging compared to UBM (50 MHz) and 20-MHz ultrasound imaging with long focal distance (patent pending PCT/FR98/02788). MATERIAL: and methods: We used an OCT3 unit dedicated to the posterior pole. By defocusing the laser beam we obtained high-resolution scans of the cornea, angle, lens and IOLs. Fifty-seven eyes (35 patients) were imaged by OCT3 and high-resolution ultrasound in cases of corneal dystrophy, corneal transplant, LASIK, narrow angle, iris bowing, etc. RESULTS: In all cases OCT3 provided high-resolution information with a limit of penetration at the posterior part of the iris. This limitation was not observed with ultrasound imaging. Nevertheless, OCT3 is a useful tool for corneal imaging in cases of opacities limiting biomicroscope imaging. OCT3 corneal scans at high resolution make it possible to identify the corneal interface in lamellar transplants or LASIK. With a narrow angle, a dynamic test of angle closure can be done. With iris bowing, OCT3 can differentiate iris cysts and iris tumors. Anterior chamber IOLs can be imaged with their relationships to anterior segment structures. CONCLUSION: OCT3 provides non-contact anterior segment imaging with high resolution but with a limit of penetration given by posterior part of the iris.     

Three-dimensional optical coherence tomography of granular corneal dystrophy

PURPOSE: To describe 3-dimensional optical coherence tomography (OCT) findings in a case of granular corneal dystrophy. METHODS: A 1310-nm high-speed swept-source OCT prototype was used to image the 3-dimensional structures of the cornea of a patient with granular corneal dystrophy. RESULTS: Three-dimensional OCT clearly showed multiple highly reflective lesions, corresponding to the deposits in the cornea. Volume of the deposits within the central 1.5 mm of the cornea was 0.11 mm and occupied 2.98% of the corneal volume. CONCLUSIONS: Three-dimensional OCT allows objective and noninvasive assessment of granular corneal dystrophy.     

Measuring total corneal power before and after laser in situ keratomileusis with high-speed optical coherence tomography

PURPOSE: To measure total corneal power using optical coherence tomography (OCT). SETTING: Refractive surgery practices at 2 academic eye centers in Cleveland, Ohio, and Los Angeles, California, USA. METHODS: Thirty-two eyes of 17 patients having myopic laser in situ keratomileusis (LASIK) were enrolled in a prospective observational study. Manifest refraction, OCT, and Placido ring corneal topography with the Atlas 995 (Carl Zeiss Meditec, Inc.) were performed preoperatively and 3 months after laser in situ keratomileusis (LASIK). A high-speed (2000 axial scans/second) corneal and anterior segment OCT prototype was used. The total corneal power was calculated by summation of the anterior and posterior surface powers, and the value was compared with that determined by simulated keratometry. Two methods of measuring total corneal power were tested: the direct method, which used OCT to measure both corneal surfaces directly, and the hybrid method, which combined OCT with anterior corneal topography. RESULTS: The repeatability (pooled standard deviation) of measuring total corneal power using the hybrid method was 3 times better than that using the direct method. It was 0.23 diopter (D) before LASIK and 0.26 D after LASIK. Preoperative total power was 1.13 D (2.6%) lower than the simulated keratometry. Compared to the LASIK-induced change in spherical equivalent refraction, the change in total corneal power was equivalent, while the change in simulated keratometry power was significantly smaller (-18.8%) (P<.001). CONCLUSIONS: Keratometry using the traditional index of 1.3375 overestimated the total power in preoperative corneas and underestimated LASIK-induced refractive change. Measuring both corneal surfaces using a combination of OCT and Placido ring topography provided a better measure of total corneal power that closely tracked the refractive change in post-LASIK eyes.     

Role of corneal elasticity in damping of intraocular pressure

PURPOSE: To determine corneal elasticity and its contribution in damping acute intraocular pressure spikes. METHODS: Twenty corneas with intact scleral rims were excised from human donor eyes and mounted on an artificial anterior chamber. A watertight seal was obtained with 17 corneas. Saline was infused into the chamber at a rate of 10 mL/h, and subsequent changes in pressure were measured to generate a pressure-volume relationship. Real-time anterior segment OCT was used to measure the change in radius of curvature and corneal thickness in nine eyes. RESULTS: The pressure-versus-volume curves of all corneal-scleral buttons were concave-up asymptotes, demonstrating elasticity. The range of the slope was 0.34 to 1.6 +/- 0.29 mm Hg/microL. The mean change in the radius of curvature in the nine eyes that were visualized by optical coherence tomography (OCT) was 247 +/- 106 microm (range, 168-412 microm). The OCT image was centered on the epithelial surface. In two eyes, the entire cornea was visible by OCT throughout the course of the experiment, and corneal thickness was measured and found to decrease by 116 +/- 4 microm. CONCLUSIONS: Human eye bank corneas demonstrate elasticity ex vivo, with expansion and thinning in response to increases in anterior chamber pressure. These elastic properties may serve as a buffering mechanism for microvolumetric changes in the eye, thus protecting the eye from intraocular pressure surges in vivo.     

Objective measurements of corneal light-backscatter during corneal swelling, by optical coherence tomography

PURPOSE: To demonstrate that corneal light-backscatter can be measured objectively during corneal swelling by optical coherence tomography (OCT). METHODS: One eye (randomly selected) of 20 non-contact-lens wearers (10 men and 10 women; mean age, 35.6 +/- 9.6 years) was patched during 3 hours of soft contact lens (SCL) wear. The contralateral eye acted as the control. Central corneal images were captured before and after SCL wear at 20-minute intervals over 100 minutes using optical coherence tomography (OCT) to obtain corneal thickness and light-backscatter profiles. OCT backscattered light of the epithelial layer (decided by the thickness measurements) and 10 equally divided layers of the remaining cornea were analyzed with a custom software program. Two baseline measurements were taken at different visits before lens wear to test the repeatability of light-backscatter measurements. RESULTS: From two baseline measurements, repeated measurements showed good repeatability of normalized backscatter results. Immediately after contact lens removal, total central corneal thickness increased significantly by 13.8% +/- 2.3% (mean +/- SD) compared with baseline (P = 0.0001, paired t-test) and then decreased during the deswelling course. Corneal backscattered light changed significantly (repeated-measures ANOVA [Re-ANOVA]: F((50, 950)) = 2.22, P = 0.0001) after lens wear, and a significant increase in backscatter was found in the epithelial layer (36.4%) and the most posterior corneal layer (35.6%) immediately after lens removal (post hoc test, P = 0.005). There was a strong correlation (r = 0.9375, P < 0.05) between the change in backscatter and corneal swelling during the deswelling period. The backscatter recovery rate was approximately the same for both epithelial and posterior layers after lens removal. CONCLUSIONS: Light-backscattering analysis with OCT seems to be a promising and repeatable method of objectively measuring corneal backscatter. This study has demonstrated that corneal backscattered light increased in the anterior and posterior layers of the cornea during corneal swelling induced by contact lens wear and eye closure.     

Optical coherence tomography of the anterior segment in secondary glaucoma with corneal opacity after penetrating keratoplasty

AIM: To evaluate secondary glaucoma after penetrating keratoplasty with anterior-segment optical coherence tomography (OCT). DESIGN: Case series. METHODS: Four eyes of four patients with corneal opacity and increased intraocular pressure (IOP) were evaluated using high-speed (2000 axial scans/s) OCT at 1.3 microm wavelength. Cross-sectional images of the anterior segment were analysed to assess the cause of increase in pressure. RESULTS: Slit-lamp evaluation of the anterior chamber in all cases was limited by corneal opacity. The OCT imaging allowed visualisation of anterior-segment structures behind the opaque corneas. Using OCT, iris-intraocular lens adhesion and pupillary block were identified as the probable reasons for the increased IOP in one case. Peripheral anterior synechiae and angle closure were identified in the three remaining cases. In two cases, we found that the tip of the aqueous drainage tube was blocked by peripheral anterior synechiae. CONCLUSIONS: OCT is similar to ultrasound in that it allows visualisation through opaque corneas. However, OCT has an advantage in that it requires neither contact nor immersion. It is a valuable tool for evaluating the depth of the anterior chamber angle and the causes of secondary angle closure.     

Corneal optical coherence tomography before and after phototherapeutic keratectomy for recurrent epithelial erosions(2)

PURPOSE: To study the representation of corneal structures with optical coherence tomography (OCT) before and after excimer laser phototherapeutic keratectomy (PTK) for recurrent epithelial erosions. SETTING: Departments of Ophthalmology, Vivantes Klinikum Neuk?lln, Berlin, and Medizinische Universit?t, Lübeck, Germany. METHODS: This prospective study comprised 15 eyes of 14 patients with recurrent epithelial erosions. The central corneal and epithelial thickness as well as the wound-healing response in the anterior corneal stroma were assessed with slitlamp-adapted OCT before and after PTK. RESULTS: After PTK, the symptoms improved in all patients without loss of best corrected, glare, or low-contrast visual acuity. The mean central corneal OCT thickness was 540 microm +/-28 (SD) preoperatively, 492 +/- 36 microm immediately after epithelial debridement and PTK, and 519 +/- 25 microm after 7 weeks (P <.01). The mean central epithelial OCT thickness changed from 70 +/- 13 microm preoperatively to 60 +/- 7 microm after 7 weeks (P >.01). Changes in the light-scattering properties in the anterior subepithelial stroma revealed a hyperreflective area with a mean thickness of 46 +/- 13 microm after 7 weeks. CONCLUSIONS: Using noncontact corneal OCT, corneal and epithelial thickness changes and the wound-healing response in the anterior corneal stroma could be evaluated after PTK in patients with recurrent epithelial erosions.     

Evaluación de los signos de la pseudoexfoliación en el segmento anterior mediante tomografía de coherencia óptica y cámara de Scheimpflug

Objective

To evaluate different anterior segment parameters in eyes with pseudoexfoliation (PSX), fellow eyes, and controls using optical coherence tomography and a Scheimpflug imaging system.

Corneal imaging with anterior segment optical coherence tomography for lamellar keratoplasty procedures

PURPOSE: To assess and describe the uses of anterior segment optical coherence tomography (OCT) in the evaluation of the cornea before and after lamellar corneal transplantation procedures. DESIGN: Prospective, noncomparative, observational case series. METHODS: Seven eyes of seven patients undergoing anterior and posterior lamellar corneal transplantation procedures at the Singapore National Eye Centre were included in the study. High-resolution anterior segment OCT scans of the cornea and anterior segment were performed both before and after lamellar transplantation procedures on the cornea with the Visante anterior segment OCT system (Visante OCT; Carl Zeiss Meditec, Inc, Dublin, California, USA), and the imaging findings were correlated with the clinical picture. Measurements of lamella thickness were performed with the software provided. RESULTS: Anterior segment OCT images were able to provide valuable information on donor apposition, Descemet membrane detachment after deep anterior lamellar keratoplasty (DALK), posterior lamellar dislocation, primary graft failure, and anterior chamber crowding with consequent chamber angle encroachment and pupillary block after Descemet stripping automated endothelial keratoplasty (DSAEK). CONCLUSIONS: Anterior segment OCT is a valuable imaging tool for assessing the feasibility of lamellar transplantation surgery in the diseased cornea and in the management of surgical complications after such procedures.     

Optical coherence tomography for the noninvasive evaluation of the cornea

PURPOSE: To determine the optical coherence tomographic (OCT) characteristics of normal corneas and to characterize the OCT images of abnormal corneal lesions. METHODS: Eleven eyes from 10 patients were examined at the Cornea Service of the Nagoya University Hospital: 4 had corneal pathologies, 4 underwent keratoplasty, and 2 were normal controls; 1 enucleated eye was also examined. OCT (OCT 2000 Zeiss-Humphrey) was used to study the normal cornea and various corneal abnormalities. We compared the OCT images to the observations made by slit-lamp biomicroscopy. RESULTS: Fluid spaces were detected as black images. A highly reflective reflex was observed at the interface of different tissues, and intensive backscattering (reflex) was seen when the incident ray hit the laminated layers vertically. Corneal opacities were not clearly imaged when they were diffuse and mild, or when they were arranged axially in a small area, as was the scar of the graft-host junction. It was possible to obtain images from the region of the cornea that was not clearly visible by slit-lamp examination because of a corneal opacity. CONCLUSION: OCT is a noncontact and noninvasive technique that can be performed safely on diseased corneas. OCT can provide objective documentation of corneal disorders that cannot be obtained by slit-lamp examination. The use of OCT in conjunction with other conventional instruments should provide a more complete image of the cornea.     

Hydration behavior of porcine cornea crosslinked with riboflavin and ultraviolet A

PURPOSE: To examine the influence of a new crosslinking treatment on corneal swelling properties that correlate with the degree of crosslinking. SETTING: Department of Ophthalmology, Vivantes-Klinikum Neuk?lln, Berlin, Germany. METHODS: Twenty freshly enucleated porcine eyes were crosslinked by applying the photosensitizer riboflavin and ultraviolet-A (UVA) light (370 nm, 3 mW/cm2) for 30 minutes. After the eyes were treated and incubated for 24 hours in a moist chamber, 15 eyes were examined by biomicroscopy and optical coherence tomography (OCT); 5 eyes were examined by light microscopy. Five control eyes were included. RESULTS: Using light microscopy, a characteristic swelling pattern with 3 zones was identified in the crosslinked porcine cornea: an anterior intensely crosslinked zone of 242 microm, an intermediate partially crosslinked zone of 238 microm (hydration factor 2.2), and a noncrosslinked posterior zone of 1355 microm (hydration factor 2.7). A condensed OCT signal was demonstrated in the treated portion of the anterior stroma to a depth of 520 microm with a pronounced line at 540 microm, correlating with the combined anterior and intermediate layers after hydration in the histological analysis. In the nonhydrated state of the crosslinked cornea, the anterior zone was deduced to be 242 microm; the intermediate zone, 109 microm; and the posterior zone, 501 microm. Therefore, the maximum depth of the crosslinking effect was 351 microm. CONCLUSIONS: Collagen crosslinking using riboflavin and UVA led to a significant change in the swelling behavior of the anterior stroma, confirming prior findings that the crosslinking effect is strongest in the anterior half of the stroma. Crosslinked cornea did not induce a specific signal on OCT, and OCT is therefore not suited for clinical controls of the crosslinking effect.     

五种检查仪器对角膜水平直径测量的对比分析

目的：分析五种角膜直径测量方法对角膜水平直径测量的相关性和一致性。

方法：纳入2018-02/03在四川大学华西医院眼科行双眼ICL植入的患者25例50眼,术前分别采用规尺、眼前节分析系统SIRIUS、IOL Master500、眼前节OCT和UBM 5种方法测量角膜水平直径,比较5种方法测量结果的相关性及一致性。

结果：规尺、眼前节分析系统SIRIUS、IOL Master500、眼前节OCT和UBM测量的角膜水平直径分别为11.54±0.30、11.77±0.33、11.98±0.33、11.63±0.35、11.53±0.34mm(P<0.05),q检验结果显示规尺法与UBM法、眼前节OCT法,UBM法与眼前节OCT法测量的WTW值之间均无差异(P>0.05),直线相关分析发现五种检查方法测量值之间均具有显著相关性,Bland-Altman分析发现,规尺与SIRIUS、UBM、眼前节OCT检查值的95%LoA上下限绝对值均≤0.50mm。

结论：五种测量角膜水平直径的结果,规尺与SIRIUS,UBM和前节OCT的结果可以互换,其他结果不能互换。IOL Master500测量值最大,不宜作为测量角膜水平直径大小的诊断依据,其他测量设备检查结果应结合临床实践。     

准分子激光治疗性角膜切削术治疗角膜浅层病变的临床观察

目的：评估眼前节OCT辅助的准分子激光治疗性角膜切削术治疗角膜浅层病变的临床效果。
　　方法：分析2012-09/2013-09在我院就诊并手术的诊断为角膜浅层病变患者15例28眼,行准分子激光治疗性角膜切削手术;术前均进行眼前节OCT检查,辅助判断病变的形态和深度,并指导PTK术中切削深度、直径等参数的设定,均随访6mo,分别观察术后6,15d;1,2,3,6mo的角膜情况、裸眼视力( uncorrected visual acuity, UCVA)、等效球镜( spherical equivalent, SE )、角膜上皮下雾状混浊( haze)的发生等。
　　结果：术后所有患者的角膜病情均有不同程度的改善,疾病的发作受到控制或发作频率明显下降,UCVA, SE,haze的发生与术前无统计学差异。
　　结论：对于角膜浅层病变的患者,眼前节OCT辅助下的准分子激光治疗性角膜切削术可以有效、准确地去除病灶,获得较好的治疗效果。但需注意控制切削深度,避免术后出现过多的远视。     

Diurnal variation of corneal and corneal epithelial thickness measured using optical coherence tomography.

PURPOSE: To determine the feasibility of optical coherence tomography (OCT) measurement of overnight corneal swelling and de-swelling and, specifically, to examine overnight changes in the corneal epithelium and recovery during the day. METHODS: Ten healthy volunteers were recruited. Corneal OCT imaging was performed at 10:00 PM (baseline), 8:30 AM, and every 2 hours thereafter until 4:30 PM. Either the right or left eye was taped shut (using a gauze pad and surgical tape) until the 8:30 AM session of the next day. Measurements were made along a 1-mm strip centered on the visual axis. RESULTS: At baseline, there were no differences in corneal or epithelial thickness between control and experimental eyes (all p > 0.05). Immediately after patch removal, corneal and epithelial thicknesses of patched eyes were higher than the baseline (all p < 0.05). In patched eyes, the cornea and epithelium swelled 5.5% and 8.1% overnight, respectively (p > 0.05). Two hours later, the epithelial thickness of the experimental eyes recovered to baseline level (p > 0.05), but corneal thickness did not reach to baseline level until 4 hours after patch removal. For control eyes, there were no differences compared with baseline (all p > 0.05). CONCLUSION: Both cornea and corneal epithelium experience proportionately similar amounts of overnight swelling. Recovery of overnight swelling may be slower for the cornea than for the epithelium. OCT provides valuable information about anterior segment morphometry.     

Imaging and quantification of calcified corneal lesions with optical coherence tomography

PURPOSE: The purpose of this study was to image and quantify calcified corneal lesions with optical coherence tomography (OCT) and to evaluate this diagnostic method to assess this corneal disease. METHODS: In a clinical study 15 eyes of 14 patients with calcified corneal lesions in the anterior portions of the cornea were assessed with slit-lamp biomicroscopy and slit-lamp-adapted OCT. The qualitative and quantitative optical changes were compared with the clinical findings. RESULTS: In corneal OCT all calcified lesions revealed marked hyperreflective changes that correlated well with macroscopic findings. Dense calcified lesions resulted in partial or complete shadowing of the posterior corneal structures. The thickness values for the hyperreflective calcified lesions ranged from 27 to 344 microm. CONCLUSION: Noncontact slit-lamp-adapted OCT may be of value in assessing calcified corneal lesions. Corneal OCT could also be used to precisely measure the depth of these corneal processes and evaluate treatment modalities.     

眼前节OCT在圆锥角膜急性角膜水肿中的运用

目的：探讨圆锥角膜急性水肿的眼前节OCT影像学特征,分析角膜水肿发生发展的原因。方法：收集8例急性角膜水肿的圆锥角膜患者,行常规眼部检查及眼前节OCT检查。结果：角膜基质层内形成一裂隙与前房相沟通。角膜基质层的厚度在发生裂隙的部位十分菲薄,甚至穿孔,发生虹膜组织嵌顿。结论：角膜基质层裂隙的形成可能是导致急性角膜水肿的一个重要原因,裂隙还可能导致持续的水肿及后弹力层的延迟愈合,严重者甚至造成角膜穿孔。     

A case of secondary glaucoma studied by optical coherence tomography of the anterior ocular segment

PURPOSE: To compare slit lamp biomicroscopy or gonioscopy with optical coherence tomography (OCT) and to assess the efficacy of OCT in a case of anterior segment disease. CASE: A 74-year-old male who had bilateral keratoconus. The left eye was aphakic, and a penetrating keratoplasty was performed on it, as well as Nd:YAG laser capsulotomy. The prognosis was good in the early postoperative stage. But 6 months postoperatively, we could not control the intraocular pressure and judged that a second operation might be needed. Before the operation, we tried to get images of the anterior segment of this eye using slit lamp biomicroscopy, gonioscopy, and OCT. RESULTS: Findings obtained by OCT were more useful than those obtained by slit lamp biomicroscopy or gonioscopy to determine the method of operation. DISCUSSION: This case substantiates the view that observation of the anterior ocular segment by OCT is useful for such cases, because in cases of corneal disease we can not get much information about the deep and endothelial side of the cornea from slit lamp biomicroscopy.     

Spectral domain anterior segment optical coherence tomography assessment of pterygium and pinguecula

Purpose: To study the morphological patterns of pterygia and pingueculae using high‐resolution anterior segment spectral domain optical coherence tomography (SD‐OCT). Methods: Prospective cross‐sectional study of 25 eyes presented with pterygia and pingueculae was conducted, and the eyes were examined by anterior segment SD‐OCT. Results: We examined 25 eyes, including 13 eyes with primary pterygia, six eyes with recurrent pterygia, one case with a pseudopterygium and five eyes with pingueculae. Primary pterygia revealed elevation of the corneal epithelium by a wedge‐shaped mass of tissue separating the corneal epithelium from the underlying Bowman’s membrane, which became wavy and interrupted. We found satellite masses of pterygium tissue advanced under the epithelium beyond the clinically seen pterygium margins. In recurrent pterygia, we detected that the central tip of the pterygium was more advanced and creeping beneath the basal corneal epithelium than the primary pterygium. In pseudopterygium, the SD‐OCT images showed that the overgrowing membrane was not really attached to the underlying cornea. In cases of pingueculae, SD‐OCT revealed a wedge‐shaped mass that was nearly similar in pattern to that of the pterygia but stopped at the limbal region. Immediately after removal of pterygia, we noticed many remnants of the pterygia masses over the corneal stroma in spite of the clinically clear appearance of cornea. Conclusions: SD‐OCT provided us with high‐resolution images of the pterygium and the pinguecula and showed clearly the anatomical relationship between the corneal tissues and these lesions. The use of this new modality of imaging may help to decrease the current recurrence rates after pterygium excision through using the anterior segment SD‐OCT in the evaluation of these lesions.