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Detection of Infectious Corneal Perforation Using Anterior Segment Optical Coherence Tomography.

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    Anterior segment optical coherence tomography (ASOCT) is a reliable tool for diagnosing corneal perforations in microbial keratitis, detecting more cases than slit lamp exams, especially in severe infections.

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    Area of Science:

    • Ophthalmology
    • Medical Imaging
    • Infectious Diseases

    Background:

    • Microbial keratitis is a serious eye infection that can lead to corneal perforation.
    • Accurate and timely diagnosis of corneal perforation is crucial for effective treatment and visual outcome.
    • Slit lamp examination is the traditional method for diagnosing corneal perforation, but its accuracy can be limited.

    Purpose of the Study:

    • To compare the diagnostic performance of anterior segment optical coherence tomography (ASOCT) with slit lamp examination for identifying corneal perforations in microbial keratitis.
    • To assess the reproducibility of ASOCT grading for corneal perforations.

    Main Methods:

    • A diagnostic concordance study was conducted on 150 eyes with microbial keratitis.
    • Two independent graders evaluated ASOCT scans for perforation, with disagreements resolved by consensus.
    • Sensitivity and specificity of slit lamp examination were calculated using ASOCT as the reference standard.

    Main Results:

    • ASOCT demonstrated near-perfect inter-grader agreement (κ=0.98).
    • ASOCT identified significantly more perforations (16.0%) than slit lamp examination (8.0%).
    • Slit lamp examination showed 33.3% sensitivity and 96.8% specificity compared to ASOCT.

    Conclusions:

    • ASOCT is a highly reproducible tool for grading corneal perforations in microbial keratitis.
    • ASOCT detects substantially more perforations than slit lamp examination, particularly in severe cases.
    • ASOCT serves as an objective tool for clinical assessment and outcome determination in microbial keratitis.