Correlation of Anterior Segment Optical Coherence Tomography and Slit-Lamp Imaging in Infectious Keratitis

Anterior segment optical coherence tomography (AS-OCT) is increasingly being used to complement slit-lamp biomicroscopy in the evaluation of corneal infections. Our purpose was to analyze, compare, and correlate the clinical signs elicited by these 2 methods in patients with infectious keratitis (IK).

Slit-lamp photomicrographs (diffuse and slit beam) and AS-OCT scans were obtained from 20 consecutive patients (21 eyes) with IK. AS-OCT horizontal line scans representing the top, middle, and bottom of the lesions were analyzed and compared with findings seen on slit-lamp photographs. Epithelial defects, thickness, irregularity; presence of infiltrate and its depth; corneal edema or melting; vascularization; Descemet membrane detachment; and presence of keratic precipitates were analyzed with both imaging techniques. AS-OCT features included hyperreflectivity, hyporeflectivity, shadowing, and tissue morphology. Statistical analysis was performed using GraphPad Prism 8.2.1.

AS-OCT was significantly more likely to detect corneal thickening ( P < 0.001), epithelial hyperplasia ( P = 0.027), infiltrate depth ( P < 0.001), presence of inflammatory plaque ( P = 0.0002), DM-endothelial complex undulations ( P < 0.001), keratic precipitates ( P = 0.0006), and Descemet membrane detachment (0.000), than slit-lamp imaging.

AS-OCT can be a helpful adjunctive test in the evaluation of patients with IK. AS-OCT complements slit-lamp biomicroscopy and photography in the diagnosis and monitoring of IK and may serve an important role in telemedicine compared with slit-lamp photography alone.