The Combined Use Of Anterior Segment Optic Coherence Tomography And In Vivo Confocal Microscopy In Monitoring Infectious Keratitis
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR205 | Type: Free paper | DOI: 10.82333/e245-0522
Authors: Dr Farida Elzawahry* 1 , Dr Sarah Donatelli 2 , Dr Prity Sahay 3 , Prof. Dr Mario Nubile 2 , A/Prof. Dalia Said 3 , Prof. Dr Harminder Dua 4
1Ophthalmology,Nottingham university hospitals ,Nottingham ,United Kingdom, 2Ophthalmology,University of Degli Studi G.D'Annuzio. ,Pescara ,Italy, 3Ophthalmology,Queens Medical Center ,Nottingham ,United Kingdom, 4Ophthalmology,Queens Medical Center ,Nottingham ,United Arab Emirates
Purpose
To evaluate anterior segment optical coherence tomography (AS-OCT) findings in infectious keratitis (IK) and to characterize AS-OCT and in vivo confocal microscopy (IVCM) features during the acute, healing, and healed stages of infection.
Setting
Outpatient cornea and ocular surface clinics at Queens Medical Center, Nottingham University Hospitals, Nottingham, United Kingdom
Methods
This prospective observational study included 29 patients with infectious keratitis of different aetiologies presenting with a corneal ulcer and/or persistent epithelial defect. All patients underwent slit-lamp examination with fluorescein staining, AS-OCT, and IVCM at initial presentation (acute stage) and at two subsequent follow-up visits representing the healing and healed stages. Imaging was used to assess the depth and thickness of stromal infiltrates, central corneal thickness, epithelial integrity, vascular changes, and cellular and structural corneal alterations over time.
Results
The mean age of patients was 56.8 ± 19.5 years. Viral keratitis was the most common aetiology (26.7%). AS-OCT demonstrated a significant reduction in stromal infiltrate thickness during the healing phase (p < 0.001). Central corneal thickness showed a significant decrease between the acute and healed stages (p < 0.001). An epithelial defect was present in all eyes at presentation; however, only 3 eyes (6.7%) showed a persistent epithelial defect at the healed stage, characterized by thickened epithelial margins. Active corneal vessels and infiltrates produced back-shadowing on AS-OCT, which progressively diminished with clinical resolution.
Conclusions
AS-OCT allows objective, non-invasive detection of structural changes in infectious keratitis. Reduction in infiltrate thickness, decreasing central corneal thickness, and fading back-shadowing from vessels and infiltrates are reliable indicators of disease resolution and may be detected before overt clinical improvement. Sequential AS-OCT imaging serves as a valuable adjunct to slit-lamp examination for monitoring treatment response in infectious keratitis.