SEMI-AUTOMATED METHOD FOR ANTERIOR SEGMENT DISEASES ASSESSMENT IN NEWBORNS WITH THE AID OF AS-OCT

To propose an exploration protocol and to develop a method that can provide objective analysis of corneal opacity in newborns with the aid of AS-OCT. 

Congenital clouding can result from various metabolic, infectious, developmental, and idiopathic causes. Comprehensive examination should be undertaken in infants presenting with any of these signs in order to achieve early diagnosis and appropriate therapy, as they can significantly improve the visual prognosis. 

 

This is a retrospective study conducted at the Department of Pediatric Ophthalmology and Strabismus of the University and Polytechnic Hospital La Fe in Valencia, Spain. Information on the clinical characteristics of newborns with corneal opacity were collected. Multiple pictures of anterior segment were acquired with AS-OCT CASIA SS-1000 (Tomey, Nagoya, Japan) as a way to obtain many enough quality images as possible. The AS-OCT images of 16 eyes were analyzed by two masked Pediatric Ophthalmologists and parameters of pachymetry, iridocorneal angle status and mean gray value (MGV) were obtained. MGV was acquired with our proposed method with the aid of ImageJ software. 

All patients underwent bilateral AS examination with AS-OCT. Four patients were female and four were male. The average of age was 12.5 days. Four patients were only 1 day old. Eight eyes were diagnosed of bilateral primary congenital glaucoma, one of secondary glaucoma after cataract surgery, four of bilateral type 1 Peters’ anomaly associated with glaucoma, and one of unilateral Descemet membrane tear secondary to forceps delivery. Inter and intraobserver reproducibility for the two examiners was very good and there was a non-significant difference in intraobserver reliability between the two observers by using the proposed method for MGV calculation. Moreover, MGV showed good correlation with clinical corneal opacity score, and enables a precise measurement of corneal opacity in a shorter period of tim, thus helping to determine the need of additional treatments such as keratoplasty. 

Prompt diagnosis is mandatory in cases of congenital corneal opacity but remains challenging on some occasions, and limited by the child’s cooperation. AS-OCT remains a rapid, noncontact and noninvasive technique, which can provide high resolution and quantitative documentation of ocular changes in newborns. The application of imaging processing techniques such as our proposed method for MGV calculation, could help in the initial evaluation and precise monitorizacion of anterior segment diseases in early childhood.