High-speed Optical Coherence Tomography for Imaging Anterior Chamber Inflammatory Reaction in Uveitis: Clinical Correlation and Grading

PURPOSE: To evaluate the anterior chamber (AC) inflammatory reaction by anterior segment high,speed optical coherence tomography (OCT). DESIGN: A prospective, nonrandomized, observational case series. METHODS: Sixty-two eyes of 45 patients were studied for AC reaction clinically and by anterior segment OCT. Hyperreflective spots suggesting the presence of cells in the AC from the OCT images were counted manually and by a custom made automated software using MATLAB (Mathworks, Natick, Massachusetts, USA) and correlated with clinical grading of AC cells using Standardization of Uveitis Nomenclature criteria. RESULTS: In manual method, mean hyperreflective spots were 3 +/- 1.8 in grade 1, 12 +/- 3.5 in grade 2, 33.8 +/- 10.2 in grade 3, and 61.4 +/- 9.6 in grade 4. Automated method showed mean 3 +/- 1.9 hyperreflective spots in grade 1, 12.4 +/- 3.6 in grade 2, 33.2 +/- 9.6 in grade 3, and 74.8 +/- 17 in grade 4. Significant difference seen in mean values between the manual and automated method in grade 4 (P = .009). AC cells were detected in 12 (19.3%) eyes with corneal edema with central corneal thickness ranging from 702 to 1020 microns (mean, 843 +/- 109 microns). Out of 62 eyes, grade 4 aqueous flare was detected by OCT imaging in 7 eyes and clinically in 5 eyes. CONCLUSION: Anterior segment OCT can be used as an imaging modality in detecting AC inflammatory reaction in uveitis and also in eyes with decreased corneal clarity and compromised AC visualization attributable to corneal edema. Automated method is sensitive in higher grades of uveitis. (Am J Ophthalmol 2009;147:413-416. (C) 2009 by Elsevier Inc. All rights reserved.)