Dynamic Optical Coherence Tomography Monitoring of Keloid Laser Treatment: A Single-Case Proof-of-Concept Study

Background: Keloids are fibroproliferative scars with a prominent vascular component, and pulsed dye laser (PDL) is an established treatment, but objective imaging biomarkers of response are lacking. Objective: To evaluate whether dynamic optical coherence tomography (D-OCT) can provide quantitative, depth-resolved monitoring of keloid vascular remodeling under PDL and to explore candidate metrics for hypothesis-generating assessment in future studies. Methods: We conducted a prospective single-case pilot, hypothesis-generating study of a thoracic keloid treated with three sessions of 595 nm PDL, acquiring D-OCT scans at baseline and approximately 30, 60, and 90 days over a standardized 4 × 4 mm region of interest at 0.15, 0.30, and 0.50 mm depths. Primary D-OCT metrics included vascular en-face area, vessel length density, junction density, and mean vessel caliber. Results: The superficial layer (0.15 mm) showed an almost complete collapse of vascular signal (area −88% vs. baseline), the intermediate layer at 0.30 mm exhibited a sustained ~39% reduction in vascular area with parallel decreases in length and caliber at stable branching, and the deep layer at 0.50 mm showed modest area changes with longer but thinner vessels. These depth-resolved changes were consistent with clinical improvement in Vancouver Scar Scale and POSAS scores. Conclusions: D-OCT yielded quantitative, clinically interpretable vascular metrics that align with the expected effects of PDL in this single patient. In this patient, the percentage reduction in vascular area at 0.30 mm by week 8 emerged as a candidate quantitative metric for response monitoring; thresholds in the order of ≥25% could be tested prospectively as hypothesis-generating cut-offs in future controlled and reliability-tested studies, but are not proposed here as validated clinical criteria.