Quantitative Analysis of Anterior Chamber Inflammation Using the Novel CASIA2 Optical Coherence Tomography

A Bibliometric Analysis of Uveitis in the Past 20 Years

PURPOSE

To assess the quantity and quality of global research on uveitis, visualize the research hotspots, and reveal the study trends in uveitis.

METHODS

This bibliometric analysis was performed with the data obtained from the Web of Science core collection (WoSCC) database and Scopus. Bibliometrix and VOSviewer were used to analyze and visualize study trends and hotspots. Citespace was used to conduct the cooperation and co-citation network analysis.

RESULTS

A total of 5837 and 7195 documents were exported for further analysis in WoSCC and Scopus, respectively. The USA has published the most articles related to uveitis (1627, 27.87%, WoS; 1979, 27.51%, Scopus) and accounted for the most frequency of total citations (42345 times total citations 35 900 times without self-citations in WoSCC database). Most of the papers focusing on uveitis were published in Ocular Immunology and Inflammation (761, 13.04% within WoS; 793, 11.02% within Scopus). Additionally, novel biotherapy is the hotspot of uveitis research which also may be a sustained research interest in the future.

CONCLUSIONS

An increasing trend of publications was found in uveitis research. The USA was the leading contributor in this field, and it was the center of cooperation network. Our study provided an overview of uveitis research, which may serve as a valuable reference and guide for stakeholders interested in uveitis.

Autostereoscopic 3D viewing can change the dimensions of the crystalline lens in myopes

PURPOSE

Autostereoscopic displays have become increasingly common, but their impact on ocular dimensions remains unknown. We sought to identify changes in the crystalline lens dimensions induced by autostereoscopic three-dimensional (3D) viewing.

METHODS

Forty young adults (age: 22.6 ± 2.0 years, male/female: 15/25) were consecutively enrolled and randomly divided into two groups (3D and two-dimensional [2D] viewing groups) to watch a 30-min movie clip displayed in 3D or 2D mode on a tablet computer. The lens thickness (LT), diameter, curvature, decentration and tilt were measured with anterior segment optical coherence tomography under both non-accommodating (static) and accommodating conditions.

RESULTS

In the static condition, the LT decreased by 0.03 ± 0.03 mm (p < 0.001) and the anterior radius of curvature (ARC) increased by 0.49 ± 0.59 mm (p = 0.001) post-3D viewing. In contrast, following 2D viewing, the ARC decreased by 0.23 ± 0.25 mm (p = 0.001). Additionally, the increase in the steep ARC post-3D viewing was greater in high-myopic eyes than low to moderate myopic eyes (p = 0.04). When comparing the accommodative with the static (non-accommodative) condition, for 3D viewing the lens decentration decreased (-0.03 ± 0.05 mm, p = 0.02); while for 2D viewing, the posterior curvature radius (-0.14 ± 0.20 mm, p = 0.006) and diameter (-0.13 ± 0.20 mm, p = 0.01) decreased.

CONCLUSIONS

Viewing with the autostereoscopic 3D tablet could temporally decrease the thickness and curvature of the lens under non-accommodating conditions. However, its long-term effect requires further exploration.

CHANGES IN SCLERAL THICKNESS IN THE ACUTE PHASE OF VOGT-KOYANAGI-HARADA DISEASE

PURPOSE

To evaluate changes in scleral thickness in Vogt-Koyanagi-Harada (VKH) disease.

METHODS

This study included 34 eyes of 17 treatment-naïve patients with acute-phase VKH disease. Scleral thickness and the presence of ciliochoroidal effusion were examined using anterior segment optical coherence tomography at baseline and 1 week, 2 weeks, and 12 weeks after the start of corticosteroid treatment. Scleral thickness was measured 6 mm posterior to the scleral spur in four directions.

RESULTS

Twenty-eight eyes (82.4%) initially had ciliochoroidal effusion, but this rapidly decreased to nine eyes (26.5%) after 1 week. The sclera with ciliochoroidal effusion became thinner from baseline to 1 week at the superior (400.2 ± 46.9-353.5 ± 47.9 µm), temporal (428.4 ± 53.6-387.8 ± 56.1 µm), inferior (451.5 ± 71.0-400.5 ± 50.5 µm), and nasal (452.4 ± 78.0-407.6 ± 62.9 µm) points (P < 0.01 for all), and no further changes were observed. The sclera without ciliochoroidal effusion remained unchanged.

CONCLUSION

In VKH disease, eyes with ciliochoroidal effusion exhibited the maximum scleral thickness during the acute phase. This thickening responded rapidly to treatment and became thinner within 1 week. Inflammation in VKH disease may affect not only the choroid but also the sclera.

Novel diagnostic indicators for acute angle closure secondary to lens subluxation based on anterior segment and lens parameters

Purpose: To explore stable and sensitive indicators for clinical diagnosis of acute angle closure (AAC) secondary to lens subluxation (LS) through quantitative analysis of CASIA 2 imaging.Design: A prospective cross-sectional study.

Methods

Setting: Clinical practice.Participants: 23 patients with unilateral acute angle closure secondary to lens subluxation and 23 cataract patients without lens subluxation were recruited. Lens subluxation was confirmed by ultrasound biomicroscope diagnosis. The contralateral eyes without LS served as fellow control group. The cataract eyes without LS were enrolled in blank control group.Intervention: Participants underwent ophthalmologic examinations including slit-lamp biomicroscope, best corrected visual acuity, intraocular pressure, central corneal thickness measurement, axial length, gonioscopy, ultrasound biomicroscope and 360-degree anterior chamber and crystalline lens scan protocols of CASIA 2 system.Main outcome measures: Automated circumferential anterior segment and lens morphological parameters under anterior segment optical coherence tomography were analyzed via three-dimensional analysis.

Results

Significant differences were found in the front and back radius of the lens, the front and back radius of steep curvature of the lens, lens thickness, lens decentration, lens diameter, iris-trabecular contact (ITC) index, ITC area, anterior chamber depth (ACD), lens vault (LV), and iris volume between LS and controls. Among these parameters, LV, the anterior radius of steep curvature of the lens and ACD demonstrated the highest prediction power (AUC = 0.87, 0.89, and 0.86, respectively). The prediction power of tilt/axis was much higher in the Gaussian Naive Bayes model (AUCs = 0.90) than in the logistic model (AUCs = 0.74). Combination of LV_mean, LV_std, tilt and tilt axis in Gaussian Naive Bayes model presented as most stable and excellent diagnostic markers for AAC secondary to LS (AUCs = 0.98).

Conclusions

The combination of markers including lens tilt and lens vault in the mathematic model facilitate clinical work as it not only provides novel diagnostic indications and possible prompt treatment for AAC secondary to lens subluxations, but also enhances our understanding of the pathogenic role of zonulopathy in angle closure glaucoma.

[Current capabilities of anterior segment optical coherence tomography]

Optical coherence tomography of the anterior segment of the eye (AS-OCT) is a non-invasive method based on the principles of optical reflectometry (measurement of the degree of backscattering of light passing through transparent or translucent media). Limitations of the first devices of this type were associated with insufficient image quality of the details of the anterior chamber angle and the posterior parts of the lens, primarily due to the "working" level of the scanning wavelength (within 800 μm). Fundamentally new possibilities in the structural and functional assessment of the anterior segment of the eye are associated with the introduction into clinical practice of swept-source AS-OCT device - the CASIA2 anterior optical coherence tomograph (Tomey Corporation, Japan). Its high scanning speed (50 000 A-scans per second) with a wavelength of 1310 μm allows high-quality visualization by building a scan at a depth of 13 mm. The previous model (CASIA SS-1000, Tomey Corporation, Japan) supported scan depth of only 6 mm. This review summarizes the results of research on the clinical use of CASIA2 tomograph.

Comparison of corneal and lens density measurements obtained by Pentacam and CASIA2 in myopes

PURPOSE

To investigate the agreement between Pentacam and CASIA2 in the evaluation of corneal densities (CDs) and lens densities (LDs) in myopes.

METHODS

Fifty-three patients (106 eyes) underwent comprehensive ophthalmologic examinations. CDs and LDs were measured using Pentacam and CASIA2, respectively, based on the grayscale percentage of the obtained images. Agreement between Pentacam and CASIA2 was evaluated using the consistency intraclass correlation coefficient (ICC) and represented using Bland-Altman plots.

RESULTS

Compared to Pentacam, CASIA2 showed significantly higher CD and LD values in all measured zones. The ICC of the average CD and LD measured by the Pentacam and CASIA2 were 0.726 and 0.757, respectively. The ICC values of all corneal zones and lenses were above 0.7, except for the measurement of the cornea in the 0-2 mm zone (0.455), suggesting good consistency between the two devices, whose results were of different levels of linear correlation. Bland-Altman plots showed mean percentages of 3.93% for the points falling outside the limits of agreement among the densitometry results. The ICCs in different age groups were similar, but the agreement was poorer in the high myopia group (low and moderate myopia, CD: 0.739, LD: 0.753; high myopia, CD: 0.621, LD: 0.760).

CONCLUSIONS

CASIA2 demonstrated good consistency with Pentacam in the measurement of CD and LD, except for measurement of CD in the central cornea and in high myopia. Despite difference in the numerical results compared with Pentacam, which made the two devices uninterchangeable, CASIA2 provides a reliable alternative densitometric measurement method.

Anterior chamber inflammation grading methods: A critical review

Assessing anterior chamber inflammation is highly subjective and challenging. Although various grading systems attempt to offer objectivity and standardization, the clinical assessment has high interobserver variability. Traditional techniques, such as laser flare meter and fluorophotometry, are not widely used since they are time-consuming. With the development of optical coherence tomography with high sensitivity, direct imaging offers an excellent alternative to assess objectively inflammation with the potential for automated analysis. We describe various anterior chamber inflammation grading methods and discuss their utility, advantages, and disadvantages.

Diagnosis, Classification, and Assessment of the Underlying Etiology of Uveitis by Artificial Intelligence: A Systematic Review

Recent years have seen the emergence and application of artificial intelligence (AI) in diagnostic decision support systems. There are approximately 80 etiologies that can underly uveitis, some very rare, and AI may lend itself to their detection. This synthesis of the literature selected articles that focused on the use of AI in determining the diagnosis, classification, and underlying etiology of uveitis. The AI-based systems demonstrated relatively good performance, with a classification accuracy of 93-99% and a sensitivity of at least 80% for identifying the two most probable etiologies underlying uveitis. However, there were limitations to the evidence. Firstly, most data were collected retrospectively with missing data. Secondly, ophthalmic, demographic, clinical, and ancillary tests were not reliably integrated into the algorithms' dataset. Thirdly, patient numbers were small, which is problematic when aiming to discriminate rare and complex diagnoses. In conclusion, the data indicate that AI has potential as a diagnostic decision support system, but clinical applicability is not yet established. Future studies and technologies need to incorporate more comprehensive clinical data and larger patient populations. In time, these should improve AI-based diagnostic tools and help clinicians diagnose, classify, and manage patients with uveitis.

Swept-source optical coherence tomography and ultrasound biomicroscopy study of anterior segment parameters in primary angle-closure glaucoma

PURPOSE

To evaluate the agreement between swept-source OCT (CASIA2) and UBM in primary angle-closure glaucoma.

METHODS

Eighty eyes of 40 participants diagnosed with primary angle-closure glaucoma were examined. Parameters measured included angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), lens vault (LV), anterior chamber depth (ACD), and anterior chamber width (ACW). Angle images of nasal, temporal, superior, and inferior were acquired by the anterior segment mode of CASIA2 and UBM. One-way analysis of variance and paired t-test were used for statistical analysis, and the agreement was analyzed by internal correlation coefficient (ICC) and Bland-Altman method.

RESULTS

One-way ANOVA pairwise comparison showed that CASIA2 or UBM had the narrowest superior chamber angle and the widest temporal chamber angle in patients with primary angle-closure glaucoma. The paired t-test showed that inter-device AOD, TIA, ARA, and TISA of superior chamber angle had significant differences (p < 0.001). There was no significant difference in the measured values of LV, ACD, and ACW (p > 0.05). The agreement of all parameters is good through the Bland-Altman method comparison. ICC result showed moderate agreement in other angle parameters except for superior ARA500 (0.739).

CONCLUSION

In the anterior chamber angle measurement process, we should pay more attention to the superior chamber angle covered by eyelids. Although the agreement is acceptable between CASIA2 and UBM, the measurements could not be considered interchangeable due to the tremendous statistical difference between the two devices.

Automated Quantitative Analysis of Anterior Segment Inflammation Using Swept-Source Anterior Segment Optical Coherence Tomography: A Pilot Study

Background: The aim of this study is to develop an automated evaluation of anterior chamber (AC) cells in uveitis using anterior segment (AS) optical coherence tomography (OCT) images. Methods: We analyzed AS swept-source (SS)-OCT (CASIA 2) images of 31 patients (51 eyes) with uveitis using image analysis software (Python). An automated algorithm was developed to detect cellular spots corresponding to hyper-reflective spots in the AC, and the correlation with Standardization of Uveitis Nomenclature (SUN) grading AC cells score was evaluated. The approximated AC grading value was calculated based on the logarithmic approximation curve between the number of cellular spots and the SUN grading score. Results: Among 51 eyes, cellular spots were automatically segmented in 48 eyes, whereas three eyes (all SUN grading AC cells score: 4+) with severe fibrin formation in the AC were removed by the automated algorithm. The AC cellular spots increased with an increasing SUN grading score (p < 0.001). The 48 eyes were split into training data (26 eyes) and test data (22 eyes). There was a significant correlation between the SUN grading score and the number of cellular spots in 26 eyes (rho: 0.843, p < 0.001). There was a significant correlation between the SUN grading score and the approximated grading value of 22 eyes based on the logarithmic approximation curve (rho: 0.774, p < 0.001). Leave-one-out cross-validation analysis demonstrated a significant correlation between the SUN grading score and the approximated grading value of 48 eyes (rho: 0.748, p < 0.001). Conclusions: This automated anterior AC cell analysis using AS SS-OCT showed a significant correlation with clinical SUN grading scores and provided SUN AC grading values as a continuous variable. Our findings suggest that automated grading of AC cells could improve the accuracy of a quantitative assessment of AC inflammation using AS-OCT images and allow the objective and rapid evaluation of anterior segment inflammation in uveitis. Further investigations on a large scale are required to validate this quantitative measurement of anterior segment inflammation in uveitic eyes.

Quantification of Anterior Chamber Particles Using Anterior Segment Optical Coherence Tomography in Angle-Closure Glaucoma Patients after Laser Iridotomy

Purpose: To determine whether the degree of particle density in the anterior chamber can be evaluated objectively and quantitatively by anterior segment optical coherence tomography (AS-OCT) in cases after laser iridotomy (LI). Methods: This was a retrospective observational study. All of the subjects who received LI for angle-closure glaucoma between January 2018 and May 2019 at Kagoshima University Hospital were studied. AS-OCT recordings were made before, immediately after, and one week after LI in 22 eyes of 14 consecutive patients. The anterior chamber particle (ACP) index was defined as the ratio of the number of particles in the anterior chamber to the total area of the anterior chamber. The ACP index was determined by binarization of the AS-OCT images and analysis with the ImageJ program. Results: The mean age of the participants was 75.4 ± 8.9 years, with a range of 61−91 years. The ACP index before the LI was 0.78 ± 0.68, and it was significantly increased to 7.72 ± 2.64 immediately after the LI (paired t-test, p < 0.01). The ACP index returned to the pre-LI density of 0.92 ± 0.48 one week after the LI. Conclusions: We successfully quantified the degree of anterior chamber particles accumulation by analyzing images obtained by AS-OCT. This simple and repeatable technique should be useful because the particles, including inflammatory cells, in the anterior chamber can be evaluated non-invasively and objectively.

Quantification of Anterior Chamber Cells in Children with Uveitis Using Anterior Segment Optical Coherence Tomography

PURPOSE

To evaluate the feasibility of anterior segment optical coherence tomography (AS-OCT) for measuring anterior chamber (AC) cells in children with uveitis and to compare different AS-OCT acquisition modes.

DESIGN

Validity and reliability analysis.

METHODS

We enrolled children younger than 18 years of age who had uveitis involving the anterior segment and children without eye disease as controls. All underwent clinical grading of AC cells. AC images of each eye were obtained using the Optovue Avanti RTVue XR AS-OCT. Two acquisition modes were used: a single cross-sectional line scan and an 8-line radial scan in an asterisk pattern. Two independent, masked graders counted cells manually on AS-OCT images. Rater agreement was assessed using intraclass correlation (ICC).

RESULTS

Included were 30 children (59 eyes) with uveitis (median age 13.0 years, range 3-17 years) and 20 control children (40 eyes, median age 10.5 years, range 4-17 years). The number of eyes assigned each clinical grade of cells were as follows: none, 32 (54%); 0.5+, 12 (20.3%); 1+, 5 (8.5%); 2+, 8 (13.6%); 3+, 2 (3.4%). ICC of graders for line and radial scan protocols were 0.87 and 0.90. There was no significant difference between acquisition modes for pooled grader results (95% confidence interval [CI] for difference: -0.04 to 0.14). ICC of cell counts between line and radial scan protocols was 0.85 (95% CI: 0.69-0.90). No control eyes had cells on AS-OCT images.

CONCLUSIONS

Quantification of AC cell in children with uveitis is feasible with AS-OCT and has excellent reliability between different graders and acquisition modes.

Artificial Intelligence and Imaging Processing in Optical Coherence Tomography and Digital Images in Uveitis

INTRODUCTION

Computer vision, understood as the area of science that trains computers to interpret digital images through both artificial intelligence (AI) and classical algorithms, has significantly advanced the analysis and interpretation of optical coherence tomography (OCT) in retina research. The aim of this review is to summarise the recent advances of computer vision in imaging processing in uveitis, with a particular focus in optical coherence tomography images.

MATERIAL AND METHODS

Literature review.

RESULTS

The development of computer vision to assist uveitis diagnosis and prognosis is still undergoing, but important efforts have been made in the field.

CONCLUSION

The automatising of image processing in uveitis could be fundamental to establish objective and standardised outcomes for future clinical trials. In addition, it could help to better understand the disease and its progression.

Quantitative and qualitative assessment of anterior segment optical coherence tomography capture of disease state in childhood anterior uveitis

BACKGROUND/AIMS

Anterior segment optical coherence tomography (AS-OCT) assessment of anterior chamber inflammation is an emerging tool. We describe the performance of AS-OCT in a paediatric population.

METHODS

A mixed-methods prospective study, using routine clinical assessment as reference standard, and AS-OCT, with Tomey CASIA2 or Heidelberg Spectralis HS1, as index test, with data collected on patient perceptions of imaging. Repeatability, diagnostic indices, responsiveness to clinical change and clinical correlations of imaging-based metrics (image cell count, size, density and brightness) were assessed, with construction of receiver operated characteristic curves. Exploratory thematic analysis of responses from families was undertaken.

RESULTS

A total of 90 children (180 eyes) underwent imaging. Bland Altman limits of agreement for CASIA2 repeatability ranged from +17 cells (95% CI 13.6 to 21.1) to -19 cells (95% CI -15.6 to -23.2) and HS1 from +1 (95% CI 0.9 to 1.2) to -1.0 (-1.2 to -0.8) cells. CASIA2 imaging had higher sensitivity of 0.92 (95% CI 0.78 to 0.97) vs HS1 imaging 0.17 (95% CI 0.07 to 0.34), with positive correlation between clinical grade and CASIA2 cell count (coefficient 12.8, p=0.02, 95% CI 2.2 to 23.4). Change in clinical grade at follow-up examinations correlated with change in image based 'cell' count (r²=0.79, p<0.001). Patients reported a potential positive impact of seeing their disease activity.

CONCLUSION

Our findings suggest that OCT-based imaging holds the promise of deeper understanding of disease, improved patient experience and more granular monitoring of activity with resultant improved outcomes, but further work is needed to refine acquisition and analysis protocols.

Grading Anterior Chamber Inflammation with Anterior Segment Optical Coherence Tomography: An Overview

The objective grading of anterior chamber inflammation (ACI) has remained a challenge in the field of uveitis. While the grading criteria produced by the Standardization of Uveitis Nomenclature (SUN) International Workshop have been widely adopted, limitations exist including interobserver variability and grading confined to discrete categories rather than a continuous measurement. Since the earliest iterations of optical coherence tomography (OCT), ACI has been assessed using anterior segment OCT and shown to correlate with slit-lamp findings. However, widespread use of this approach has not been adopted. Barriers to standardization include variability in OCT devices across clinical settings, lack of standardization of image acquisition protocols, varying quantification methods, and the difficulty of distinguishing inflammatory cells from other cell types. Modern OCT devices and techniques in artificial intelligence show promise in expanding the clinical applicability of anterior segment OCT for the grading of ACI.

Novel Findings of Retinal and Choroidal Features Utilizing Optical Coherence Tomography Angiography Analysis in Patients With Autoimmune Posterior Uveitis

Purpose: To analyze the quantitative parameters acquired by optical coherence tomography angiography (OCTA) in patients with autoimmune posterior uveitis. Methods: OCTA images of 65 eyes affected with uveitis and 65 normal control (NC) eyes were obtained. The central macular thickness (CMT), retinal thicknesses, foveal avascular zone (FAZ) area, foveal density 300 μm (FD300), and vascular density (VD) were compared among acute uveitic eyes, chronic uveitic eyes, and NC eyes. VDs were evaluated in the choriocapillaris, outer retina, optic disk, whole and parafovea superficial capillary plexus (SCP), and whole and parafovea deep capillary plexus (DCP). Correlation analysis was used to analyze the relationship between LogMAR best-corrected visual acuity (BCVA) and quantitative parameters from OCTA. Results: Compared with NC eyes, the CMT and retinal thicknesses were increased significantly in eyes with uveitis (p < 0.05, respectively). No significant difference was observed in the FAZ area. FD300, VDs in the optic disk, SCP, and DCP both in whole image and parafovea, choriocapillaris were significantly decreased in uveitis eyes (p < 0.05, respectively) compared with NC eyes, only the acute group had decreased VD of the outer retina and choriocapillaris compared with the NC group (p < 0.05). Moreover, quantitative parameters of OCTA showed a significant correlation with LogMAR BCVA in the patients with uveitis. Whole VD DCP was the best predictive factor for BCVA in the patients with uveitis. Conclusion: Quantitative measurement by OCTA is a promising strategy for objective assessment of autoimmune posterior uveitis.

Lens Biometry in Congenital Lens Deformities: A Swept-Source Anterior Segment OCT Analysis

Aims: To investigate the lens biometric parameters in congenital lens deformities, using a novel technique of swept-source anterior segment optical coherence tomography (SS-ASOCT).

Methods: This prospective study included patients with microspherophakia (MSP), coloboma lentis (CL), and posterior lenticonus (PL). For this cohort, 360-degree high-resolution lens images were obtained using the latest SS-ASOCT (CASIA2, Tomey Corp, Nagoya, Japan). The lens biometric parameters were calculated by the CASIA2 built-in software for anterior lens radius (ALR), posterior lens radius (PLR), anteroposterior distance (APD), anterior chamber depth (ACD), equatorial diameter (Eq Dia), rear projection length (RPL), and maximum diameter of the lesion (MDL).

Results: This study included two eyes each with MSP and CL and one eye with PL. The lens of MSP was spherical and posteriorly dislocated, with decreased ALR and PLR, Eq Dia, but increased APD. In patients with CL, the coloboma was isolated, bilateral, inferior, and located toward the maldeveloped ciliary body. High astigmatism was mainly lenticular, and this was calculated by the ALR and PLR. Regarding the site of coloboma, a significant decrease in ALR was observed, while the PLR and APD were not affected. The PL eyes had a cone-shaped protrusion of the posterior lens surface with a subtle cataractous region around the apex. An extremely high posterior surface curvature was observed with a mean PLR of 1.67 mm. The RPL and MDL were about 1.80 and 0.4 mm, respectively, which were homogenous at different sections.

Conclusions: The CASIA2 is a valuable option for in vivo crystalline lens measurement for congenital lens deformities, enabling the accurate diagnosis and providing illuminating insights into the pathogenesis of MSP, CL, and PL

Development of fully automated anterior chamber cell analysis based on image software

Optical coherence tomography (OCT) is a noninvasive method that can quickly and accurately examine the eye at the cellular level. Several studies have used OCT for analysis of anterior chamber cells. However, these studies have several limitations. This study was performed to supplement existing reports of automated analysis of anterior chamber cell images using spectral domain OCT (SD-OCT) and to compare this method with the Standardization of Uveitis Nomenclature (SUN) grading system. We analyzed 2398 anterior segment SD-OCT images from 34 patients using code written in Python. Cell density, size, and eccentricity were measured automatically. Increases in SUN grade were associated with significant cell density increases at all stages (p < 0.001). Significant differences were observed in eccentricity in uveitis, post-surgical inflammation, and vitreous hemorrhage (p < 0.001). Anterior segment SD-OCT is reliable, fast, and accurate means of anterior chamber cell analysis. This method showed a strong correlation with the SUN grade system. Also, eccentricity could be helpful as a supplementary evaluation tool.

Anterior Segment-Optical Coherence Tomography features in Blau syndrome

Blau syndrome (BS) is a rare granulomatous auto-inflammatory disease, characterized by the classic clinical triad of joints, skin and ocular involvements. Ocular manifestation usually consists in a bilateral insidious chronic anterior uveitis with a potential evolution to panuveitis. We describe the case of two siblings, an 8-years old female and a 5-years old male, with a diagnosis of BS, evaluated by Anterior Segment-Optical Coherence Tomography (AS-OCT). In the female patient, slit-lamp examination revealed bilateral anterior granulomatous uveitis and inflammatory sequelae. AS-OCT revealed high intensity reflective layers in the anterior cornea, hyperreflective dots both in the aqueous humor and in the posterior corneal surface. In the male, no signs of inflammation were detected both on slit-lamp examination and AS-OCT scans. AS-OCT is a valuable, non-invasive tool that could improve the diagnosis of ocular involvement, better characterize and follow-up corneal alterations and anterior segment features in pediatric patients with BS.

Subtle changes of the crystalline lens after cycloplegia: a retrospective study

BACKGROUND

The purpose of this study was to evaluate the shape of the crystalline lens in terms of biometry and diopters before and after cycloplegia using the CASIA2 swept-source (SS) optical coherence tomography (OCT) system on the anterior segment.

METHODS

This was a retrospective study. Children and adolescents (26 males and 29 females, aged 4-21 years) with simple ametropia were selected for optometry and CASIA2 imaging at 2 separate visits before and after cycloplegia. Diopter values were derived from the spherical power (S) obtained by optometry. Biometric parameters of the crystalline lens, including the anterior chamber depth (ACD), anterior and posterior curvature of the lens (ACL and PCL), lens thickness (LTH), lens decentration (LD), lens tilt (LT), and equivalent diameter of the lens (LED), were measured by the CASIA2 system. The differences in these parameters after compared with before cycloplegia were determined, and their relationships were analyzed.

RESULTS

Fifty-five participants (106 eyes) were initially enrolled. There was a significant difference (P < 0.05) in the S (t=-7.026, P < 0.001), ACD (t=-8.796, P < 0.001), ACL (t=-13.263, P < 0.001) and LTH (t = 7.363, P < 0.001) after compared with before cycloplegia. The change in the PCL (t = 1.557, P = 0.122), LD (t = 0.876, P = 0.383), LT (t = 0.440, P = 0.661) and LED (t=-0.351, P = 0.726) was not statistically significant (P > 0.05). There was a significant (P < 0.05) correlation of the change in the S with that in the ACL (r = 0.466, P < 0.001), LTH (r=-0.592, P < 0.001), and LED (r = 0.223, P = 0.021) but not the PCL (r = 0.19, P = 0.051), LD (r=-0.048, P = 0.0628) or LT (r=-0.022, P = 0.822). Furthermore, the change in the ACD was closely related to the change in crystalline morphology. However, in children and adolescents, we found that the change in crystalline morphology was unrelated to age.

CONCLUSIONS

Changes in lens morphology after compared with before cycloplegia are mainly related to the ACL and LTH, but there is no difference in the PCL, LD, LT, or LED. In the adolescent population, change in the S is related to change in the ACL, LED and LTH. However, age is unrelated to the shape and tendency of the crystalline lens. Further research is required to determine whether the same conclusion applies to different age groups and different refractive states (myopia, hyperopia, emmetropia) .