Unveiling Corneal Pathology: The Contribution Of Anterior Segment Optical Coherence Tomography (As-Oct) In The Management Of Infectious Keratitis.

Published 2024 - 42nd Congress of the ESCRS

Reference: PO258 | Type: Poster | DOI: 10.82333/xgt3-ay46

Authors: Aymen Mabrouk* ¹ , Nadia Ben Abdesslem ¹ , Chaima Mefteh ¹ , Ines Nouira ¹ , Ahmed Mahjoub ¹ , Mohamed Ghorbel ¹

¹ophtalmology,farhat hached university Hospital ,sousse ,Tunisia

Purpose

To explain the contribution of the AS-OCT in the diagnosis, management and follow up of infectious keratitis.

Setting

This study was conducted on Tunisian patients living in Tunisia, north Africa. After the clinical examination of the patients, all of them underwent a corneal scraping followed by a microbiological testing and were treated accordingly. Apart from the clinical slit lamp examination to monitor the evolution of the lesions, AS-OCT was performed initially, after starting the treatment and during the follow up.

Methods

A case series of 5 infectious keratitis patients hospitalized in our department. All patients underwent microbiological testing and were treated accordingly, while being monitored frequently with clinical examination and AS-OCT.

Results

Microbiological tests yielded positif for four patients confirming Fusarium, Pseudomonas aeruginosa, Acanthamoeba, and filamentous keratitis. Two cases involved contact lens use, one had ocular trauma. AS-OCT facilitated early detection of intrastromal cysts and endothelial plaques in mycotic keratitis, guiding prompt early treatment initiation. Pseudomonas keratitis also showed necrotic intrastromal cysts. Acanthamoeba keratitis exhibited
hyperreflective lesions in the corneal stroma. AS-OCT aided in evaluating therapeutic response and pre-keratoplasty scar assessment for a patient with recurrent disciform keratitis. Tailored treatments were administered with continuous disease monitoring and prognosis determination using AS-OCT.

Conclusions

Slit-lamp biomicroscopy's assessment of corneal lesions is limited by light's physical properties, hindering accurate depth evaluation despite dual-plane examination. Anterior segment optical coherence tomography (AS-OCT) offers objective analysis by quantifying corneal metrics like thickness, infiltrate depth, and extent. AS-OCT visualization of endothelial plaques and mycotic intrastromal cysts aids in pathogen prediction. Furthermore, AS-OCT's qualitative and quantitative assessment facilitates post-treatment monitoring, scarring evaluation, and corneal thickness measurement,
especially in the sequelae phase, though no OCT sign is pathognomonic, mandating corroborative clinical and microbiological analysis.