EVALUATION OF ANTERIOR CHAMBER INFLAMMATORY REACTION BY ANTERIOR SEGMENT HIGH-SPEED OPTICAL COHERENCE TOMOGRAPHY Presenter DR SOOSAN JACOB MS,FRCS,DNB,MNAMS CO AUTHORS PROF AMAR AGARWAL MS, FRCS,FRCOpth DR DHIVYA ASHOK KUMAR MD DR ATHIYA AGARWAL

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EVALUATION OF ANTERIOR CHAMBER INFLAMMATORY
REACTION BY ANTERIOR SEGMENT HIGH-SPEED OPTICAL
COHERENCE TOMOGRAPHYPresenter DR SOOSAN JACOB
MS,FRCS,DNB,MNAMS CO AUTHORSPROF AMAR AGARWAL
MS, FRCS,FRCOpthDR DHIVYA ASHOK KUMAR MDDR
ATHIYA AGARWAL MD,DODR AGARWALS EYE HOSPITAL
EYE RESEARCH CENTRECHENNAI, INDIAAUTHORS HAVE
NO FINANCIAL INTEREST
Category Intraocular Surgery (Cataract and
Refractive)
Poster no P- 85
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MATERIALS AND METHODS

• We evaluated the anterior chamber inflammatory
  reaction by anterior segment high speed Optical
  Coherence Tomography (OCT) by an prospective non
  randomized observational case series
• Sixty two eyes of 45 patients were studied
  for anterior chamber (AC) reaction clinically.
• Hyper reflective spots suggesting the
  presence of cells in the AC from the OCT
  images(Carl Zeiss Meditec, California, USA) were
  counted manually and by a custom made automated
  software using MATLAB and correlated with
  clinical grading of anterior chamber cells using
  Standardization of Uveitis Nomenclature (SUN)
  criteria.

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OCT GRADING

• The corneal high resolution (10mm x 3mm) single
  scan mode was used.
• The single capture image of the anterior chamber
  included all the structures from the central
  cornea to the anterior capsule of lens.
• The hyper-reflective spots detected in the
  anterior chamber were counted manually .
• MATLAB software was used for automated counting

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ANTERIOR CHAMBER CELLULAR REACTION OBSERVED IN
OCT IMAGE IN EDEMATOUS/OPAQUE CORNEAS
Corneal edema and resultant opacity is a
limitation for clinical visualization of anterior
chamber
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KERATIC PRECIPITATES
FIBRIN IN AC
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DISTRIBUTION OF EYES IN THE STUDY
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Graph showing the results of manual and automated
method, suggesting higher sensitivity of the
automated method at higher grades of uveitis.
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Comparison of means of manual and automated method
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Hyper reflective spots tabulation
Slit lamp Grading of Anterior chamber cells Mean number of hyper reflective spots Upper 95 confidence interval Lower 95 confidence interval
1.00 3.00 2.28 3.72
2.00 12.00 9.48 14.52
3.00 33.80 21.03 46.57
4.00 61.43 52.46 70.39
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DISCUSSION

• .
• Hyper reflective spots that are picked up in
  the anterior chamber might be due to cellular
  clumps whose size are large enough to be picked
  up by the OCT. Size less than the axial
  resolution(18 microns) of OCT were difficult to
  detect.
• Clumping occurs due to cell to cell
  adhesion, either between inflammatory cells or
  between inflammatory cells and pigment cells
  released from the iris, along with increased
  protein and fibrin content of aqueous in inflamed
  eyes.

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CONCLUSION

• we found that both manual and automated anterior
  segment OCT grading correlated with clinical slit
  lamp grading.
• At higher grades of uveitis automated method has
  higher sensitivity than manual method.
• In conditions where corneal clarity is reduced,
  anterior segment OCT can be used to see the
  cellular reaction, fibrinous reaction or membrane
  endothelial infiltrates and keratic precipitates
• Agarwal A, Ashokkumar D, Jacob S et al.
  High-speed Optical Coherence Tomography for
  Imaging Anterior Chamber Inflammatory Reaction in
  Uveitis Clinical Correlation and Grading.Am J
  Ophthalmol. 2009 Mar147(3)413-416