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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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the predictive value of anterior segment optical coherence tomography (AS-OCT) for postoperative corneal edema in cataract patients. Methods: A retrospective cohort study of 144 cataract patients from December 2020 to December 2021 was conducted. Patients were divided into edema eyes (84 cases) and observation (60 cases) group based on postoperative corneal edema occurrence. Relevant indicators were compared between groups. Logistic regression identified risk factors for postoperative corneal edema. Receiver operating characteristic curves evaluated the predictive value. Results: The edema eyes group had significantly higher postoperative central corneal thickness (CCT) and lower postoperative endothelial cell density (ECD) than the observation group (P < 0.05). The edema eyes group also had significantly lower preoperative ECD, anterior chamber depth (ACD), anterior chamber angle (ACA), and preoperative lens position (LP) than the observation group (P < 0.05). Logistic regression analysis showed that preoperative ECD, ACD, ACA, and LP were independent risk factors for postoperative corneal edema (P < 0.05), all of which also showed good predictive value for postoperative corneal edema, with areas under the curve (AUCs) of 0.854, 0.812, 0.791, and 0.778, respectively, under the ROC curve analysis. Conclusion: AS-OCT can provide useful information for predicting postoperative corneal edema in cataract patients. Preoperative ECD, preoperative ACD, preoperative ACA, and preoperative LP are important parameters that can be measured by AS-OCT and used as risk factors for postoperative corneal edema. [ABSTRACT FROM AUTHOR]

Background: The surgical parameters of phacoemulsification can significantly impact the behavior of the anterior hyaloid membrane (AHM). Methods: In this prospective study, anterior segment optical coherence tomography was used to examine the attachment or detachment of the AHM of 82 eyes after uneventful phacoemulsification preoperatively and postoperatively over 1 year. The impacts of the capsulorhexis' size, number of hydrodissections, nuclear sclerosis grade, cumulative dissipated energy (CDE), ultrasonic time, total surgical time, weakness of zonular fibers, presence of lens materials in Berger's space (LM-BS), and fluid usage were investigated in relation to the behavior of the AHM. Results: A significant linear trend regarding anterior vitreous detachment (AVD) was observed in the presence of zonular weakness and high CDE at all postoperative times (p ≤ 0.024 and p ≤ 0.005, respectively). Similarly, AVD was observed at 1-month, 3-month, and 1-year follow-ups in cases of high nuclear sclerosis grades (p ≤ 0.044) and high fluid usage (p ≤ 0.021). A significant correlation was observed in the group of LM-BS as the zonular weakness value increased (OR: 0.085; 95% CI: 0.017 to 0.420; p = 0.002), and the fluid usage was also significantly higher (OR: 1.049; 95% CI: 1.003–1.096; p = 0.037). Conclusions: Zonular weakness, high CDE, a hard nucleus, and high fluid usage are risk factors for postoperative AVD. [ABSTRACT FROM AUTHOR]

We report a case of personalized exclusive brachytherapy treatment for the management of a highly recurrent squamous cell conjunctival carcinoma with corneal invasion. This is a case of a Caucasian 81-years-old man who presented 10 years ago to our clinic with a pink-white para-limbal mass with dilated feeder arteries and mild leukoplakia. Excisional biopsy confirmed the presence of conjunctival intraepithelial neoplasia (CIN). Successively, he underwent two 4-weeks cycles of Mytomicin C topical therapy and a second excisional surgery, due to several recurrences of the lesion. At the last relapse, the pink-white peri-limbic mass which invaded the corneal limbus, determining corneal opacification from 5- to 7-clock hours, was confirmed by anterior segment optical coherence tomography (AS-OCT). Due to resistance to MMC therapy and chronic epitheliopathy, an AS-OCT guided exclusive radiotherapy plan was set: a Rhutenium-106 CCD plaque was applied directly over the afflicted corneal surface, the corneal limbus and the neighboring sclera for 24 hours. The remission of both conjunctival and corneal malignancy was complete 2 months after surgery and no signs of recurrence were highlighted at AS-OCT analysis at the 2-year follow up. Brachytherapy treatment showed optimal management of both corneal and conjunctival involvement, with a free-of-disease follow-up of 24-months. This result suggests that, in specific conditions, Ru-106 brachytherapy could be an effective option of treatment even if not associated with surgical excision. [ABSTRACT FROM AUTHOR]

PurposeTo describe examination and imaging characteristics of presumed iris papulosa in a case of ocular syphilis.ObservationsA 60-year-old man who presented with granulomatous anterior uveitis in his left eye was also noted to have an unusual vascularized iris papule associated with posterior synechiae at the nasal pupillary margin. Anterior segment OCT (AS-OCT) of the iris lesion demonstrated a hyperreflective anterior surface with multiple vascular lumen, internal hyperreflectivity, and shadowing. Ultrasound biomicroscopy (UBM) imaging revealed an echodense mass with relative hyperechogenicity in the anterior portion of the lesion. Systemic work-up confirmed a diagnosis of syphilis, and he was treated with topical steroids and parenteral penicillin.Conclusion and importanceWe characterize the rare finding of iris papulosa that may be encountered in syphilitic uveitis and its distinctive features on both UBM and AS-OCT. This report highlights that syphilis should be considered as a possible diagnosis for an undifferentiated vascular iris mass.

This case report aims to present the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in three patients with iridocorneal endothelial (ICE) syndrome. Three female patients 37, 50, and 57 years of age presented with complaints of unilateral visual impairment and elevated intraocular pressure (IOP). Biomicroscopy revealed unilateral pupil irregularities and anterior synechiae, and gonioscopy demonstrated synechiae in the iridocorneal angle. IOP was within normal limits with medical treatment in two patients, while one patient had an IOP of 44 mmHg despite maximal antiglaucomatous treatment. IVCM revealed large, polymorphic, and hyperreflective cells in the corneal endothelial layer of the affected eyes and normal corneal epithelium, stroma, and endothelium in the fellow eyes. AS-OCT findings were normal in healthy eyes, while the affected eye showed synechiae in the iridocorneal angle and a hyperreflective, thickened endothelial layer. The patient with refractory glaucoma underwent trabeculectomy surgery with 5-fluorouracil. In conclusion, IVCM and AS-OCT allow a detailed examination of endothelial cell abnormalities and iridocorneal membranes in ICE syndrome, which is characterized by unilateral pupil and iris irregularities and anterior synechiae mainly in women.

Abstract Purpose: This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary open-angle glaucoma (POAG). Methods: In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup–disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up. Results: A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 ± 8.73 years, and the majority of the cases were male (n = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 ± 7.22 mmHg on 2.47 ± 1.1 medications, and the mean postoperative IOP reduced to 11.11 ± 2.58 mmHg on 0.11 medications, which was statistically significant (P < 0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant. Conclusion: This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm's canal diameter is necessary to explain the precise mechanisms of lowering the IOP.

Abstract Background Paraproteinemic keratopathy is a rare disorder characterized by the bilateral accumulation of polychromatic deposits diffusely in all corneal layers together or not with diffuse or patchy pseudo lipid deposits. We present an atypical case of paraproteinemic keratopathy which lead to an initial misdiagnosis of infectious crystalline keratopathy. Case presentation a 69-year-old woman with an asymptomatic keratopathy detected during a cataract intervention. Slit-lamp examination revealed several hyper refringent subepithelial foci with fern-shaped branches, resembling crystalline keratopathy, in her left eye. Anterior segment optical coherence tomography revealed exclusively subepithelial hyperreflective lesions limited to the anterior stroma. The progressive bilateralization and progression of the condition prompted us to include other entities with crystalline corneal deposits in our differential diagnosis. Hematological analysis showed a high number of free Kappa light chains. Despite the typical clinical appearance of crystalline keratopathy, the atypical evolution and test results led us to consider that monoclonal gammopathy could be the cause of this entity. Conclusions Paraproteinemic keratopathy may present in its early stages as a unilateral subepithelial crystalline keratopathy. Thus, it must always be taken into account in the differential diagnosis of any crystalline keratopathy, particularly when there are no predisposing factors for an infectious crystalline keratopathy. Early recognition of this rare entity is important to address the associated potentially serious systemic disease.

Background: Paraproteinemic keratopathy is a rare disorder characterized by the bilateral accumulation of polychromatic deposits diffusely in all corneal layers together or not with diffuse or patchy pseudo lipid deposits. We present an atypical case of paraproteinemic keratopathy which lead to an initial misdiagnosis of infectious crystalline keratopathy. Case presentation: a 69-year-old woman with an asymptomatic keratopathy detected during a cataract intervention. Slit-lamp examination revealed several hyper refringent subepithelial foci with fern-shaped branches, resembling crystalline keratopathy, in her left eye. Anterior segment optical coherence tomography revealed exclusively subepithelial hyperreflective lesions limited to the anterior stroma. The progressive bilateralization and progression of the condition prompted us to include other entities with crystalline corneal deposits in our differential diagnosis. Hematological analysis showed a high number of free Kappa light chains. Despite the typical clinical appearance of crystalline keratopathy, the atypical evolution and test results led us to consider that monoclonal gammopathy could be the cause of this entity. Conclusions: Paraproteinemic keratopathy may present in its early stages as a unilateral subepithelial crystalline keratopathy. Thus, it must always be taken into account in the differential diagnosis of any crystalline keratopathy, particularly when there are no predisposing factors for an infectious crystalline keratopathy. Early recognition of this rare entity is important to address the associated potentially serious systemic disease. [ABSTRACT FROM AUTHOR]

Background: Swept-source anterior segment optical coherence tomography (SS-AS-OCT) is a suitable examination for the vitreolenticular interface. Methods: In a prospective study using Anterion (Heidelberg Engineering, Heidelberg, Germany), 102 eyes of 102 patients were examined in pupil dilation, preoperatively and 6 times over 1-year follow-up. Preoperatively anterior hyaloid membrane (AHM) visibility was determined with Imaging App with high reliability. Postoperatively capsular bag–AHM distance was measured on six points by using Metrics App. Results: The AHM was visible in 18.6% preoperatively and postoperatively as well (Group 1), 49% of the preoperatively adherent AHMs became visible (Group 2A), 32.4% remained attached (Group 2B). Group 1: the average deepest point on the first day was 782.5 ± 324.1 microns, and it significantly differed from the later follow-up values. Group 2A: the average deepest value was 184.1 ± 220.1 microns, and there was no statistically significant difference between the postoperative visit values. The difference between the groups was statistically significant at every location and at each time point. Conclusions: AS-SS-OCT can be used to check BS both preoperatively (with limitations) and postoperatively. [ABSTRACT FROM AUTHOR]

Ocular burns can have three origins: chemical (by acid or alkaline agents), luminous (by ultraviolet radiation) or thermal. We report the cases of eight patients with ocular burns (3 thermal and 5 chemical). Of these, one patient had a grade 2 burn according to the Dua classification, two had grade 3 damage and one had grade 4. One patient had grade 3 damage in the right eye and grade 4 in the left eye. Anterior segment optical coherence tomography (AS-OCT) was performed in two patients, showing corneal de-epithelialization, corneal thickening and a hyper-reflective line in the posterior stroma. All patients received medical treatment with topical antibiotics, topical corticosteroids, cycloplegics and wetting agents. Five patients had outpatient treatment with clinical improvement. Three patients were hospitalized, one of whom received an amniotic membrane graft (AMG), one had an AMG followed by a transfixing keratoplasty (TK), and the other is scheduled for a TK. Ocular burns are associated with significant functional risk, warranting prompt and effective management. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in thickness of tissues, specifically the pericardium patch graft (PPG) covering the silicone tube in Ahmed Glaucoma Valve (AGV) surgery. Study design: Prospective observational study. Methods: This study included cases with refractory glaucoma that underwent AGV implantation with PPG coverage. Conjunctival epithelium, stroma and PPG thickness covering the tube were measured using anterior segment optical coherence tomography (AS-OCT) at 1, 6 and 12 months. Additionally, the same measurements were taken 1500 µm away from the tube as a control for the central measurements. Results: Twenty-seven eyes of 27 patients were evaluated in the study. Although PPG thickness decreased significantly in both regions, the amount of reduction was more pronounced centrally. Centrally, the reduction rate was 21.2% and 34.8% during the 1-6 months period and 6-12 months period, while peripherally it was 3.5% and 5.1%, respectively. No change was observed in the thickness of the epithelium during the follow-up period. There was a significant thinning of the stroma in the central and peripheral regions during the 1-6 months period (30.5% and 17%, respectively). No cases of exposure were observed during the follow-up period. Conclusion: Although the most evident thinning of the layers covering the tube was observed in the early postoperative period, PPG showed a stable decrease even in the late period. The progressive reduction in the PPG thickness observed also in the peripheral region indicates that factors beyond mechanical forces contribute to this degenerative process. AS-OCT could be a valuable non-invasive tool in clarifying this process. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo report the clinical presentation, anterior segment optical coherence tomography features, treatment, and outcomes of ocular surface squamous neoplasia (OSSN) associated with pterygium.Retrospective interventional series of 14 cases in a 28-month study period.OSSN was coexistent with pterygium (n = 14) in < 1% of all pterygia (n = 7384). The mean age at the presentation of OSSN with pterygium was 49 years (median, 49 years; range, 36 to 71 years). Referral diagnosis included pterygium sans OSSN (n = 7, 50%), granuloma (n = 1, 7%), actinic keratosis (n = 1, 7%), and conjunctivitis (n = 1, 7%). All OSSNs were unilateral, and six patients (43%) had bilateral pterygia. Tumors arose from the nasal (n = 8, 57%), or temporal (n = 6, 43%) quadrants. The mean tumor diameter was 4 mm (median, 4 mm; range, 2 to 6 mm), and the mean thickness was 2 mm (median, 1 mm; range, 1 to 3 mm). The delineation between OSSN and pterygium could be identified on anterior segment optical coherence tomography (AS-OCT) in all (100%) cases. All patients received 1% topical 5-fluorouracil (5-FU), and complete tumor regression was achieved in 13 (93%) cases with a mean number of 2 cycles (median, two cycles; range, 1 to 4 cycles). There were no significant adverse effects. No tumor recurrence was noted over a mean follow-up period of 11 months (median 12 months; range, 1 to 4 months)AS-OCT allows accurate detection and mapping of tumor extent in OSSN with coexistent pterygium, and topical 5-FU yields excellent tumor control. [ABSTRACT FROM AUTHOR]

Differentiation of iris and ciliary body lesions as benign or malignant and cystic or solid is important. The aim of this study was to compare anterior segment swept-source optical coherence tomography (AS SS-OCT) and ultrasound biomicroscopy (UBM) findings in iris and ciliary body tumors. Forty-two eyes of 38 cases with iris and ciliary body tumors imaged with UBM and AS SS-OCT between September 2018 and September 2023 were evaluated retrospectively. Of 42 eyes, 14 had melanoma, 14 iris pigment epithelial (IPE) cysts, 7 nevi, 3 Lisch nodules, 2 iris stromal cysts, 1 pars plana cysts, and 1 iris mammillations. An equivalent (100%) visualization of the anterior tumor margin was obtained with both techniques. Compared to AS SS-OCT, UBM was superior for posterior margin visualization in melanocytic tumors and IPE cysts. Bland-Altman plots demonstrated good agreement between UBM and AS SS-OCT for melanocytic tumors < 2.5 mm in base diameter and < 2 mm in thickness. Although, UBM is the gold standard for ciliary body and iridociliary tumors. AS SS-OCT should be considered as an excellent alternative to UBM, especially in minimally elevated iris lesions. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to present the characteristics of deeply embedded metallic corneal foreign bodies using anterior segment optical coherence tomography (AS-OCT). Materials and Methods: The study included one eye of 163 patients who presented with a deeply embedded, metallic corneal foreign body to an ophthalmological emergency clinic. All patients were assessed using anterior segment photographs and AS-OCT to determine the characteristics of the foreign bodies and wound features. All foreign bodies were removed, and wound debridement was performed. Results: The study population included 160 men and 3 women with a mean age of 32.1±8.4 years. The mean diameter of the foreign body and burn halo were 776.8±21.1 μm and 1299.6±54.2 μm, respectively. The mean areas of the foreign body and burn halo were 0.41±0.14 mm2 and 0.81±0.32 mm2 . The mean foreign body penetration depth was 141.0±26.0 μm. During follow-up, there was no corneal foreign bodies-related keratitis in any patients. A decrease in visual acuity was observed in all patients with central cornea involvement. In these cases, the mean final visual acuity was 20/25 (20/20 to 20/32). Conclusion: This study showed that AS-OCT can define characteristics of corneal wounds associated with metallic foreign bodies. By detecting the diameter and depth of the foreign body in AS-OCT images, the size of the corneal scar that will occur after the injury can be predicted. Being able to make this estimation is critical, especially in centrally located foreign bodies, as it will reduce visual acuity. [ABSTRACT FROM AUTHOR]

Context Pharmacological mydriasis possibly is associated with intraocular pressure (IOP) rise and anterior chamber angle changes. Hence, this study is focused on pressure analysis with anterior segment optical coherence tomography measurements of angle parameters during various dilation phases. Aims Purpose is to investigate IOP variations during dilation phases and to discover association of anterior segment optical coherence tomography measurements. Settings and design Observational study. Patients and methods Thirty-two participants were recruited and IOP measured by rebound tonometer in pre, mid, and full pupillary dilation phases. Lens vault (LV at horizontal and vertical), angle opening distance (AOD at 500 and 750 μm) and trabecular iris space area (TISA at 500 and 750 μm) in temporal and nasal scans were quantified. Paired t test performed to establish a statistical significance P value less than or equal to 0.05. Statistical analysis used MS Excel. Results A total of 32 participants with mean age of 47.5±10.94 years consisting of 17 (53.13%) males and 15 (46.87%) females with 20 (62.5%) right and 12 (37.5%) left eyes were investigated. Mean IOP in pre, mid, and full-dilation phases were 14.86 ±2.87, 15.94±2.72, and 15.63±2.69 mmHg. Predilation IOP with IOP in mid and full dilation showed statistical significance (P=0.0001, 95% confidence interval 0.56–1.56) and 0.88 and 0.85 Pearson’s coefficients, respectively. IOP analysis with LV, AOD, and TISA in pre, mid, and full-dilation phases exhibited a significant difference (P<0.0001). Conclusion This research highlights an increase in IOP alongside a noteworthy decrease in the average LV by 30.94 μm during mid-dilation compared to the predilation phase. Likewise, the AOD at 750 μm demonstrated a significant reduction by 0.40 and 0.45 μm in temporal scans during mid and full dilation, respectively, while TISA remained unchanged. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary openangle glaucoma (POAG). Methods: In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup-disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up. Results: A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 ± 8.73 years, and the majority of the cases were male (n = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 ± 7.22 mmHg on 2.47 ± 1.1 medications, and the mean postoperative IOP reduced to 11.11 ± 2.58 mmHg on 0.11 medications, which was statistically significant (P <0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant. Conclusion: This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm's canal diameter is necessary to explain the precise mechanisms of lowering the IOP. [ABSTRACT FROM AUTHOR]

Purpose: To report the use of anterior segment optical coherence tomography (AS-OCT) for superficial keratectomy (SK) in anterior corneal opacity. Methods: The characteristics of 43 eyes (39 patients) with various lesions responsible for anterior corneal opacity were included in this retrospective non-comparative study. AS-OCT was performed on all eyes before surgery. The thickness of corneal opacity and the underlying healthy stroma were measured. SK was performed on each individual. Results: Four types of anterior corneal opacity were evaluated, including corneal degeneration (26/43), Reis-Bücklers corneal dystrophy (8/43), alkali burn (1/43) and corneal tumors (8/43). Based on AS-OCT images, all eyes showed abnormal hyper-reflective signals in the superficial cornea to less than one-third of the normal corneal thickness in the deepest corneal opacity. All 43 eyes underwent an SK procedure. In addition, 1 eye with alkali burns and 7 eyes with corneal tumors were combined with amniotic membrane transplantation. All eyes restored transparency without significant complications. Conclusion: AS-OCT is a valuable method for objective preoperative and noninvasive assessments of anterior corneal opacities and is useful for guiding SK.

Purpose: To develop and validate deep learning algorithms that can identify and classify angle-closure (AC) mechanisms using anterior segment optical coherence tomography (AS-OCT) images. Methods: This cross-sectional study included participants of the Handan Eye Study aged ≥35 years with AC detected via gonioscopy or on the AS-OCT images. These images were classified by human experts into the following to indicate the predominant AC mechanism (ground truth): pupillary block, plateau iris configuration, or thick peripheral iris roll. A deep learning architecture, known as comprehensive mechanism decision net (CMD-Net), was developed to simulate the identification of image-level AC mechanisms by human experts. Cross-validation was performed to optimize and evaluate the model. Human-machine comparisons were conducted using a held-out and separate test sets to establish generalizability. Results: In total, 11,035 AS-OCT images of 1455 participants (2833 eyes) were included. Among these, 8828 and 2.207 images were included in the cross-validation and held-out test sets, respectively. A separate test was formed comprising 228 images of 35 consecutive patients with AC detected via gonioscopy at our eye center. In the classification of AC mechanisms, CMD-Net achieved a mean area under the receiver operating characteristic curve (AUC) of 0.980, 0.977, and 0.988 in the cross-validation, held-out, and separate test sets, respectively. The best-performing ophthalmologist achieved an AUC of 0.903 and 0.891 in the held-out and separate test sets, respectively. And CMD-Net outperformed glaucoma specialists, achieving an accuracy of 89.9 % and 93.0 % compared to 87.0 % and 86.8 % for the best-performing ophthalmologist in the held-out and separate test sets, respectively. Conclusions: Our study suggests that CMD-Net has the potential to classify AC mechanisms using AS-OCT images, though further validation is needed.

Background: Recognizing the risk factors and understanding the mechanisms underlying steroid-induced ocular hypertension (SIOH) are vital to prevent potent vision loss and ensure the safety and effectiveness of dexamethasone (DEX) injections. The study aimed to develop a novel nomogram for predicting the risk of SIOH and determining safety zones for steroid injections. Methods: This single-center, retrospective, case-control study included a total of 154 eyes with available measured axial length that had undergone AS-OCT and DEX implantation at the Yonsei University Health System. The eyes were categorized into the SIOH (n = 39) and post-steroid normal IOP (n = 115) groups. We measured intraocular pressure (IOP) for all eyes prior to DEX implantation, at 1 week post-implantation, and at 1, 2, 3, 6, and 12 months thereafter. We used AS-OCT to analyze the trabecular meshwork (TM) height and ocular parameters. Results: The predictive nomogram, including TM height, yielded an AUC of 0.807 (95 % confidence interval [CI], 0.737–0.877) and demonstrated significantly higher predictive accuracy than that of previous nomograms, which did not consider TM height and had an AUC of 0.644 (95 % CI, 0.543–0.745) (p = 0.031). The calibration plot demonstrated a strong predictive accuracy for a predicted value of approximately 0.4. We established cutoff values to ensure different levels of sensitivity and specificity within the safety zone following DEX implantation. Conclusion: Our improved nomogram incorporating TM height as a newly identified risk factor, established a safety threshold for intravitreal DEX implantation, helping identify safe individuals from those who require caution.

Objective: The purpose of this study was to report a case of herpes simplex virus-1 (HSV-1) keratitis misdiagnosed as fungal keratitis due to its clinical presentation being similar to that of fungal keratitis, ultimately diagnosed by NGS. Patients and Methods: A 59-year-old male presented with reduced vision in the right eye, combined with a history of trauma with vegetative matter. The corneal ulcer was accompanied with feathery infiltration, satellite lesion, and endothelial plaques. In vivo confocal microscopy (IVCM) showed hyper-reflective linear, thin, and branching interlocking structures. Fungal keratitis was diagnosed. Voriconazole 100 mg orally daily, topical tobramycin and 1% voriconazole were initiated empirically right away. The condition was aggravated and penetrating keratoplasty was performed. Anterior segment optical coherence tomography (AS-OCT) demonstrated the presence of plaques with a clear boundary between plaques and endothelium, resembling the AS-OCT images observed in cases of viral keratitis. Next-generation sequencing (NGS) further detected HSV-1 deoxyribonucleic acid, and no fungal component was found. Antifungal agents were discontinued and antiviral treatments were added. Results: We successfully treated a patient with HSV-1 keratitis who was misdiagnosed due to clinical features and IVCM findings similar to fungal keratitis. The patient's infection was controlled. At 2 years after surgery, the cornea recovered well. Conclusions: HSV-1 keratitis with atypical clinical presentation can be easily misdiagnosed. This case report emphasizes the importance of NGS in diagnosing the pathogens of keratitis. [ABSTRACT FROM AUTHOR]

AimsTo evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SL) wear in patients with limbal stem cell deficiency (LSCD).DesignRetrospective consecutive case series.Methods27 eyes with LSCD confirmed by in vivo confocal microscopy at the Stein Eye Institute and fitted with SL were included. Correlations between corrected distance visual acuity (CDVA) and LSCD stage determined by clinical grading were performed between baseline (after the SL fit) and the last follow-up (the time of discontinuation of SL wear or the last visit in eyes in which SL were continued). In a subset of patients that had worsened LSCD while using SL, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed.ResultsBaseline LSCD grading was stage I in 12 eyes (44.4%), stage 2 in 12 eyes (44.4%), and stage III in 3 eyes (11.1%). At the last follow-up, CDVA was improved in 7 eyes (25.9%), remained stable in 13 eyes (48.1%) and decreased in 7 eyes (25.9%, P = 0.16). The LSCD stage was improved in 7 eyes (25.9%), remained stable in 8 eyes (29.6%) and worsened in 12 eyes (44.4%, P = 0.10). AS-OCT and AS-FA, performed in 5 eyes, showed limbal compression and delayed fluorescein filling.ConclusionSL can improve visual acuity and maintain the ocular surface in the majority of eyes. Worsening of the ocular surface might be a result of limbal hypoxia. Close monitoring of SL fit is necessary in these compromised eyes.

Aims To assess the lower lacrimal punctal measurements in patients with punctal stenosis versus normal participants using anterior segment optical coherence tomography (AS-OCT). Patients and methods The study included 39 puncti of 21 healthy asymptomatic volunteers attending the general and oculoplastic outpatient clinics (group I: control group) and 30 puncti of 17 patients with a clinical diagnosis of punctal stenosis defined as the punctal diameter less than 0.3 mm measured by slit-lamp biomicroscopy (group II: cases group). The punctal diameter is measured by slit-lamp biomicroscopy in all participants. The external punctal diameter, the inner punctal diameter at three depths (100, 200, and 500 μm), the punctal depth and tear meniscus height were measured using AS-OCT. Results The internal punctal diameter at 100 μm (239.51±91.14 vs. 168.77±118.07 µm), 200 μm (156.67±75.20 vs. 71.63±76.41 µm), and 500 μm (74.92±60.99 vs. 24.07±34.30 µm) showed statistically significant lower measurements in the cases group compared with the control group. No statistically significant differences were found comparing both groups regarding external punctal diameter otherwise. In the cases group, the punctal diameter measured by slit-lamp biomicroscopy had highly significant statistical evidence of positive correlation with the internal punctal diameter at 200 μm. Conclusion AS-OCT provides a superior ability to assess the patency of the proximal lacrimal drainage system over the routine slit-lamp examination, especially when the internal punctal diameter is measured at a depth of 200 µm. Further research is required to build consensus on standard terminologies, define the standard measurements, and acquire more extensive normative databases. This would mostly be useful in diagnosis of cases of epiphora with externally nonstenosed puncti and distally patent passages.

Introduction: Lacteocrumenasia is a relatively rare postoperative complication of cataract surgery. It is classified as a late-onset type of capsular block syndrome (CBS) and is often accompanied by myopia; however, its mechanism is not clearly understood. Case Presentation: We report a case of a 62-year-old male patient having CBS with myopia. The patient was treated with neodymium-yttrium aluminum garnet (Nd-YAG) laser posterior capsulotomy. We measured and compared the depth of the intraocular lens using anterior segment optical coherence tomography (AS-OCT) before and after laser treatment. Treatment resulted in refraction improvement of more than 1.0 diopters. The intraocular lens depth before and after Nd-YAG laser irradiation had very mild changes of less than 0.05 mm, which did not explain the refractive changes. Conclusion: Myopia in the early-onset type of CBS is caused by anterior deviation of the intraocular lens; however, the evaluation of this case using AS-OCT suggested that an abnormal intraocular lens position may not be involved in late-onset CBS.

A 45 year old male patient was referred to Department of Ophthalmology for conjunctival cyst in his left eye. His ophthalmic examination revealed conjuctival cyst formation in temporal conjuctiva. Both eyes had uncorrected vision of 1.0. The intraocular pressures were measured to be normal. The fundus examination revealed normal findings. A nail had struck his left eye 2 days ago. The orbital computed tomography (CT) scan was reported to be normal but anterior segment optical coherence tomography of the cyst was clinically inconclusive for a simple cyst. The patient underwent exploration of the left eye and an occult scleral penetration was noted.

Purpose: To report a rare case of globe rupture with broken calcified senile scleral plaque (SSP). Observations: A 94-year-old male patient presented with left eye pain and severely decreased left vision immediately after the injury while farming. Examination of the left eye revealed edematous cornea, diffuse subconjunctival hemorrhage, total hyphema and iris prolapse. Preoperative computed tomography (CT) scan revealed calcified SSP in both eyes, and the calcified SSP was found to be broken during surgery. Although it was impossible to thread the broken calcified SSP, threading and suturing with long bites outside of the broken calcified SSP was effective for wound closure. Postoperatively, we were able to observe the broken calcified SSP and the wound closure using anterior segment optical coherence tomography (AS-OCT). Conclusions and importance: In a case of globe rupture with calcified SSP on preoperative CT, the possibility that the SSP has also ruptured should be considered. AS-OCT is also useful to observe the wound in a case of globe rupture with broken SSP during follow-up.

Purpose: To report a rare case of a conjunctival blue nevus in a child. Observations: A 10-year-old girl underwent an excisional biopsy for an atypical growing melanocytic conjunctival lesion. The diagnosis of a conjunctival blue nevus was confirmed on histopathology. We describe the histopathology and the anterior segment optical coherence tomography features of a blue nevus in a 10-year-old child along with a review of literature. Conclusion and importance: Conjunctival blue nevus is rare and has rarely been reported in a child. Multimodal imaging may help document lesion progression. This condition should remain in the differential for a growing, pigmented conjunctival lesion.

Background: To assess the anterior scleral thickness (AST), Schlemm's canal diameter (SCD), trabecular meshwork diameter (TMD) and conjunctiva tenon capsule thickness (CTT) in high myopic (HM) subjects and HM subjects with glaucoma (HMG) compared to control eyes. Methods: One hundred and twenty eyes were included, and AST at 0, 1, 2 and 3 mm from the scleral spur, SCD, TMD and CTT were measured. Results: Mean age was 64.2 ± 11.0 years, and the temporal SCD and temporal TMD were significantly longer in the HMG subjects compared to the controls (380.0 ± 62 μm vs. 316.7 ± 72 μm, p = 0.001) and (637.6 ± 113 μm vs. 512.1 ± 97 μm, p = 0.000), respectively. There were no significant differences between the HM and HMG subjects in SCD and TMD (all p > 0.025). Compared to the HM subjects, the temporal AST0 (432.5 ± 79 μm vs. 532.8 ± 99 μm, p = 0.000), temporal AST1 (383.9 ± 64 μm vs. 460.5 ± 80 μm, p = 0.000), temporal AST2 (404.0 ± 68 μm vs. 464.0 ± 88 μm, p = 0.006) and temporal AST3 (403.0 ± 80 μm vs. 458.1 ± 91 μm, p = 0.014) were significantly thinner in the HMG group. No differences were found between the CTT in the three groups (all p > 0.025). Conclusions: Our data indicate a thinner AST in HMG subjects and no differences in SCD and TMD between HM and HMG subjects. [ABSTRACT FROM AUTHOR]

Fuchs endothelial corneal dystrophy (FECD) is a complex genetic disorder characterized by the slow and progressive degeneration of corneal endothelial cells. Thus, it may result in corneal endothelial decompensation and irreversible corneal edema. Moreover, FECD is associated with alterations in all corneal layers, such as thickening of the Descemet membrane, stromal scarring, subepithelial fibrosis, and the formation of epithelial bullae. Hence, anterior segment imaging devices that enable precise measurement of functional and anatomical changes in the cornea are essential for the management of FECD. In this review, the authors will introduce studies on the application of various imaging modalities, such as anterior segment optical coherence tomography, Scheimpflug corneal tomography, specular microscopy, in vitro confocal microscopy, and retroillumination photography, in the diagnosis and monitoring of FECD and discuss the results of these studies. The application of novel technologies, including image processing technology and artificial intelligence, that are expected to further enhance the accuracy, precision, and speed of the imaging technologies will also be discussed. [ABSTRACT FROM AUTHOR]

Purpose: To compare the refractive efficacy and morphological changes in the cornea following a novel biphasic higher fluence transepithelial corneal crosslinking (BI-TE-CXL) and transepithelial corneal crosslinking (TE-CXL) in adults keratoconus. Methods: Patients with progressive keratoconus who required corneal crosslinking were assigned to the BI-TE-CXL group (32 eyes, phase 1: 7.2 J/cm2 for 5 min and 20 s of pulsed-light exposure, KXL, Glaukos-Avedro; phase 2: 3.6 J/cm2 for 6 min and 40 s of continuous light exposure at the front curvature apex with a 6 mm diameter light spot, UVX-2000, IROC) or the TE-CXL group (32 eyes, uniform 7.2 J/cm2 for 5 min and 20 s of pulsed-light exposure, KXL, Glaukos-Avedro). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal fluorescein staining (CFS), corneal topography, anterior segment optical coherence tomography (AS-OCT), and in vivo corneal confocal microscopy (IVCM) were performed 3, 6, 12 and 24 months after surgery. Results: The CFS scores in the BI-TE-CXL group were significantly higher than those in the TE-CXL group on the first two days after surgery (p < 0.001). The Kmax (at 12 and 24 months) and CDVA (logMAR) were significantly lower in the BI-TE-CXL group than those in the TE-CXL group (p < 0.05). The corneal demarcation line under AS-OCT was visible in 81.3% of patients in the BI-TE-CXL group and 15.6% in the TE-CXL group. The depth of the demarcation line under IVCM was significantly deeper in the BI-TE-CXL group (248.3 ± 25.0 μm) than that of the TE-CXL group (136.5 ± 15.6 μm) in the central cornea (p < 0.001). The cross-linked collagen structures in the central cornea were still present after 12 months in the BI-TE-CXL group. No significant difference in sub-basal nerve density between the two groups (p > 0.05). Conclusions: Following BI-TE-CXL, CDVA was significantly improved, accompanied by deeper demarcation line depth and persistent crosslinked structures in the central corneal stroma. [ABSTRACT FROM AUTHOR]

Introduction: Lacteocrumenasia is a relatively rare postoperative complication of cataract surgery. It is classified as a late-onset type of capsular block syndrome (CBS) and is often accompanied by myopia; however, its mechanism is not clearly understood. Case Presentation: We report a case of a 62-year-old male patient having CBS with myopia. The patient was treated with neodymium-yttrium aluminum garnet (Nd-YAG) laser posterior capsulotomy. We measured and compared the depth of the intraocular lens using anterior segment optical coherence tomography (AS-OCT) before and after laser treatment. Treatment resulted in refraction improvement of more than 1.0 diopters. The intraocular lens depth before and after Nd-YAG laser irradiation had very mild changes of less than 0.05 mm, which did not explain the refractive changes. Conclusion: Myopia in the early-onset type of CBS is caused by anterior deviation of the intraocular lens; however, the evaluation of this case using AS-OCT suggested that an abnormal intraocular lens position may not be involved in late-onset CBS. [ABSTRACT FROM AUTHOR]

Aims To assess the lower lacrimal punctal measurements in patients with punctal stenosis versus normal participants using anterior segment optical coherence tomography (AS-OCT). Patients and methods The study included 39 puncti of 21 healthy asymptomatic volunteers attending the general and oculoplastic outpatient clinics (group I: control group) and 30 puncti of 17 patients with a clinical diagnosis of punctal stenosis defined as the punctal diameter less than 0.3 mm measured by slit-lamp biomicroscopy (group II: cases group). The punctal diameter is measured by slit-lamp biomicroscopy in all participants. The external punctal diameter, the inner punctal diameter at three depths (100, 200, and 500 μm), the punctal depth and tear meniscus height were measured using AS-OCT. Results The internal punctal diameter at 100 μm (239.51±91.14 vs. 168.77±118.07 µm), 200 μm (156.67±75.20 vs. 71.63±76.41 µm), and 500 μm (74.92±60.99 vs. 24.07±34.30 µm) showed statistically significant lower measurements in the cases group compared with the control group. No statistically significant differences were found comparing both groups regarding external punctal diameter otherwise. In the cases group, the punctal diameter measured by slit-lamp biomicroscopy had highly significant statistical evidence of positive correlation with the internal punctal diameter at 200 μm. Conclusion AS-OCT provides a superior ability to assess the patency of the proximal lacrimal drainage system over the routine slit-lamp examination, especially when the internal punctal diameter is measured at a depth of 200 µm. Further research is required to build consensus on standard terminologies, define the standard measurements, and acquire more extensive normative databases. This would mostly be useful in diagnosis of cases of epiphora with externally nonstenosed puncti and distally patent passages. [ABSTRACT FROM AUTHOR]

Purpose: Corneal scars after infectious keratitis lead to insufficient transparency and irregular astigmatism, affecting visual acuity; therefore, they should be accurately evaluated to estimate visual function. This study aimed to quantitatively evaluate corneal irregularity and scarring after infectious keratitis using anterior segment optical coherence tomography (AS-OCT). Methods: This was an observational clinical study. We included patients who had corneal scarring after treatment of infectious keratitis between 2014 and 2021 at University of Tokyo Hospital. We retrospectively examined best spectacle-corrected visual acuity (BSCVA), average keratometric power, central corneal thickness (CCT), and four components of the Fourier harmonic analysis including spherical and asymmetry components, as well as regular astigmatism and higher-order irregularity. We included anterior and posterior corneal data and compared results with those of contralateral healthy eyes. Additionally, we quantitatively evaluated the densitometry of the cornea obtained using AS-OCT. Results: A total of 122 eyes of 61 patients were examined; male predominance was observed (n = 37), and the mean patient age was 55.3 ± 19.4 years. Comparisons with contralateral healthy eyes showed that BSCVA worsened (0.30 ± 0.83 and 0.93 ± 1.36 logMAR, respectively, P = 0.003), and CCT (531.1 ± 46.2 and 591.8 ± 132.4 μm, respectively, P < 0.001) and corneal densitometry (84.4 ± 11.8 and 111.9 ± 19.2 grayscale units, respectively, P < 0.001) increased significantly in affected eyes. The asymmetry component and higher-order irregularities that were not corrected with spectacles significantly increased (both P < 0.001), and there were no significant differences in the changes among the bacterial, fungal, herpetic, and acanthamoeba types of keratitis. Conclusion: Corneal scarring persisted after treatment for infectious keratitis, and the asymmetry and irregularities of corneal astigmatism increased as visual acuity deteriorated. AS-OCT with the Fourier harmonic analysis was useful for evaluating corneal topographic changes in patients with corneal scarring after keratitis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the correlation between clinical tests, patient symptoms, and conjunctivochalasis in contact lens wearers and non-wearers. Methods: This study comprised 40 eyes of 40 current soft contact lens users and 40 eyes of 40 control subjects. Cross-sectional areas of conjunctivochalasis at three locations (nasal, central, temporal) during straight and downward gazes were determined using anterior segment optical coherence tomography in all participants. Tear film break up time test and Schirmer test with anesthesia were performed and for evaluation of symptoms, the participants completed ocular surface disease index questionnaire. Results: During straight gaze, the mean cross-sectional areas of conjunctivochalasis were 0.0112 ± 0.009 and 0.006 ± 0.005 mm2 at nasal, 0.0096 ± 0.007 and 0.002 ± 0.004 mm2 at central, 0.0176 ± 0.014 and 0.008 ± 0.009 mm2 at temporal in contact lens and control groups, respectively. Regardless of location and gaze direction, the mean cross-sectional conjunctivachalasis areas of the contact lens group were significantly higher than those of the controls (all, p < 0.05). Significant positive correlations between ocular surface disease index score and measured conjunctivachalasis areas (in all sites) during straight gaze and downward gaze were observed in the contact lens group (all, p < 0.05 and r > 0.450). Conclusion: Wearing soft contact lenses is associated with increased conjunctivochalasis areas. Anterior segment optical coherence tomography determined conjunctivochalasis area is an objective clinical measurement value that is positively correlated with patients’ symptoms in soft contact lens wearers. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study is to evaluate the effects of diabetic retinopathy and intravitreal injections on the corneal, limbal and scleral areas. Methods: Patients with diabetes mellitus at different diagnosis and treatment levels were compared among themselves and with the control group in terms of corneal, limbal and scleral aspects with the help of anterior segment optical coherence tomography. In addition, clinical tests such as tear break-up time, Schirmer test-I and ocular surface disease index questionnaire were applied to the patients and the difference between the groups was investigated. Results: When the groups were examined in terms of BUT, SCH-I and OSDI, there was a statistically significant difference between control group and diabetic group(p < 0.05). In the limbal region, all measurements are higher than in patients with diabetic eye involvement. Thinning was detected in the scleral area with intravitreal injection (p < 0.05). Conclusion: It should be known that DM may cause undesirable changes in the limbal region, and the importance of non-invasive detection with AS-OCT should not be forgotten. Since intravitreal injections for DME cause thinning of the sclera, it can cause various complications, and it may be recommended to change the quadrant in repetitive injection applications. [ABSTRACT FROM AUTHOR]

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Purpose: To report a case of metallic corneal foreign-body (CFB) penetrating the Laser in situ keratomileusis (LASIK) flap and its successful outcome. To highlight usefulness of Anterior Segment Optical Coherence Tomography (ASOCT) in diagnosis and management of post-LASIK CFB. To enumerate other similar cases published in literature. Method: A 30-year-old male presented to the emergency department of a tertiary eye care centre with a metallic CFB. He had undergone uneventful LASIK elsewhere 4-years back. He was unaware of any trauma. CFB removal was attempted elsewhere but abandoned as CFB appeared deeply embedded. ASOCT showed CFB had penetrated LASIK flap and lodged into midstroma, 207 μm deep. CFB was successfully removed in operation theatre along with the application of cyanoacrylate glue and bandage contact lens. A review of literature for CFB in post-LASIK patients was done through PubMed search. Result: Postoperative course was uncomplicated and there was a follow up period of 4 months. Vision improved to unaided 20/20 and N/6 from preoperative 20/60 and N/10. Review of literature of 24 patients showed Post-LASIK FB was more common in males (79%). None of the patients except for one had protective eye-wear. Metallic FB was most common followed by organic FB. Flap complications were present in seven patients. Diffuse lamellar keratitis (DLK) and epithelial ingrowth were the most common post-FB removal complications occurring in six (25%) and four (16.6%) patients respectively. Conclusion: Post-LASIK patients with CFB need to be inspected for flap related complications. CFB can be successfully removed, although DLK, epithelial ingrowth, microbial keratitis, astigmatism, can occur post-CFB removal. ASOCT can delineate CFB and flap related details and thus is an additional useful imaging tool in such scenarios.

PurposeTo 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.DesignValidity and reliability analysis.MethodsWe enrolled children younger than 18 years 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).ResultsIncluded 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% 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.ConclusionsQuantification of AC cell in children with uveitis is feasible with AS-OCT and has excellent reliability between different graders and acquisition modes.

Background: The surgical parameters of phacoemulsification can significantly impact the behavior of the anterior hyaloid membrane (AHM). Methods: In this prospective study, anterior segment optical coherence tomography was used to examine the attachment or detachment of the AHM of 82 eyes after uneventful phacoemulsification preoperatively and postoperatively over 1 year. The impacts of the capsulorhexis’ size, number of hydrodissections, nuclear sclerosis grade, cumulative dissipated energy (CDE), ultrasonic time, total surgical time, weakness of zonular fibers, presence of lens materials in Berger’s space (LM-BS), and fluid usage were investigated in relation to the behavior of the AHM. Results: A significant linear trend regarding anterior vitreous detachment (AVD) was observed in the presence of zonular weakness and high CDE at all postoperative times (p ≤ 0.024 and p ≤ 0.005, respectively). Similarly, AVD was observed at 1-month, 3-month, and 1-year follow-ups in cases of high nuclear sclerosis grades (p ≤ 0.044) and high fluid usage (p ≤ 0.021). A significant correlation was observed in the group of LM-BS as the zonular weakness value increased (OR: 0.085; 95% CI: 0.017 to 0.420; p = 0.002), and the fluid usage was also significantly higher (OR: 1.049; 95% CI: 1.003–1.096; p = 0.037). Conclusions: Zonular weakness, high CDE, a hard nucleus, and high fluid usage are risk factors for postoperative AVD.

Purpose: To assess the repeatability and reliability of semi-automated EyeMark Python program measurements compared to manual ImageJ image processing of anterior segment-optical coherence tomography (AS-OCT) structures in healthy and keratoconus eyes. Methods: Heidelberg AS-OCT was used to image 25 eyes from 14 healthy subjects and 25 eyes from 15 subjects with keratoconus between the ages of 20 and 80 years, collected prospectively, in this observational case–control study. Visual axis scan containing vertical fixation light beam was selected from the 15-line AS-OCT scan raster. Central corneal thickness (CCT), anterior corneal radius of curvature (ACRC), posterior corneal radius of curvature (PCRC), and truncated anterior vault (TAV) were measured using ImageJ software and the EyeMark Python program. MedCalc and R were used to calculate the intraclass correlation coefficient (ICC) and generate Bland–Altman plots (BAP). Results: When comparing the measurements of CCT, ACRC, PCRC, and TAV between manual ImageJ analysis and the EyeMark Python program, ICC values were consistently greater than 0.9, indicating excellent agreement. BAPs comparing the ImageJ and Python measurements of anterior segment structures show no systematic proportional bias and the average differences were near zero and within 95% of the limits of agreement. Conclusions: Semi-automated tools may provide the necessary efficiency for point-of-care quantitative corneal analysis of raw AS-OCT images. The semi-automated EyeMark Python program offers a repeatable and reliable tool compared to manual ImageJ analysis for measuring anterior segment structures from AS-OCT images among individuals with keratoconus. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the link between the capsular bend and the morphological types and characteristics of posterior capsular opacification (PCO) using anterior segment optical coherence tomography. Methods: Thirty eyes with PCO were examined, and three types of PCO were identified: pearl, fibrosis, and mixed. We assessed anterior capsular overlap, intraocular lens-capsule adhesion, and capsular bending. In addition to measuring the intraocular lens-posterior capsule distance and capsule bending angle (CBA), the PCO parameters (area, density, and score at 6-, 5-, and 3-mm intraocular lens optic regions) were recorded. The associations between capsular bend and PCO type and characteristics were investigated. A control group of 12 eyes without PCO was used to compare the study variables. Results: With p values greater than 0.001, there was a statistically significant difference in the mean PCO area and score at the 6-, 5-, and 3-mm optic zones in different PCO types, with the pearl type having the highest value, followed by the mixed type, and finally the fibrosis type. The PCO group had a significantly higher mean CBA than the control group (P = 0.001). CBA was positively related to intraocular lens-posterior capsule distance, PCO area, and PCO score at the 6-, 5-, and 3-mm zones (P = 0.001). The receiver operating characteristic curve's cut-off point for CBA was 96.85° when comparing PCO cases to controls. Partial overlap and incomplete adhesion were statistically more common in the PCO eyes than in the control (P = 0.001, 0.003, respectively). Conclusion: PCO types and CBA have a strong relationship with PCO score and intraocular lens-posterior capsule space. In PCO's eyes, CBA has a cut-off value of 96.85°. [ABSTRACT FROM AUTHOR]

Background: Evaluation of ocular inflammation via common imaging modalities like optical coherence tomography (OCT) has emphasised cell visualisation, but automated detection of uveitic keratic precipitates (KPs) remains unexplored. Methods: Anterior segment (AS)‐OCT dense volumes of the corneas of patients with uveitic KPs were collected at three timepoints: with active (T0), clinically improving (T1), and resolved (T2) inflammation. At each visit, visual acuity and clinical grading of the anterior chamber cells were assessed. A bespoke algorithm was used to create an en face rendering of the KPs and to calculate their volume and a ratio of the volume of precipitates over the analysed area. The variation of AS‐OCT‐derived measurements over time was assessed, and compared with clinical grading. Results: Twenty eyes from 20 patients (13 females, mean age 39 years) were studied. At T0, the mean volume of the corneal KPs was 0.1727 mm3, and it significantly reduced to 0.1111 mm3 (p = 0.03) only at T2. The ratio between the volume of the KPs and the corneal area decreased from T0 (0.007) to T1 (0.006; p = 0.2) and T2 (0.004; p = 0.009). There was a statistically significant correlation between the AC cell count and the AS‐OCT volume measurements of the KPs at the three time points. Conclusions: AS‐OCT can image uveitic KPs and through a bespoke algorithm we were able to create an en face rendering allowing us to extrapolate their volume. We found that objective quantification of KPs correlated with inflammatory cell counts in the anterior chamber. [ABSTRACT FROM AUTHOR]

Mucopolysaccharidosis are group of inherited metabolic diseases caused by the absence or malfunctioning of lysosomal enzymes resulting in accumulation of glycosaminoglycans. Over time this accumulation damages cells, tissues, and organs. There are seven types of MPS and 13 subtypes that are associated with multiple organ systems, such as the respiratory, liver, spleen, central nervous systems, arteries, skeletons, eyes, joints, ears, skin, and/or teeth. The various types share some common ocular features that differ in terms of the severity of the affection. Visual loss in MPS patients is varied and can be due to corneal clouding, glaucoma, retinopathy, and optic neuropathy. The primary focus of this review is on changes in the cornea and anterior segment in MPS patients, including clinical and novel investigative modalities, current surgical management, effects of systemic therapy like hematopoietic stem cell transplants (HSCT)and enzyme replacement therapy (ERT), as well as significant research developments. [ABSTRACT FROM AUTHOR]

Aim of the study: To evaluate the results and recurrence of pterygium after surgical treatment of the primary condition with autotransplantation of the conjunctival tissue of the ipsilateral eye to the defect site at our workplace with a follow-up period of at least one year. Material and methods: The medical documentation of all patients who underwent primary pterygium surgery with conjunctival autograft in the monitored period February 2018 to July 2019 was retrospectively evaluated. The authors mainly studied the recurrence of the disease using this surgical technique. Furthermore, the influence on visual functions, refractive parameters and possible complications of therapy was evaluated. The average follow-up time of our cohort was 21.8 months. Results: We did not observe recurrence in any patient during the entire follow-up period. Uncorrected visual acuity was improved by at least one line of the logMAR optotype in 5 eyes and corrected visual acuity in 2 eyes. According to Wilcoxon's paired test, changes in uncorrected and corrected visual acuity were not statistically significant at a significance level of 0.05. In 5 patients the astigmatism was reduced by at least 0.5 cylindrical diopters (Dcyl), while in other patients the astigmatism remained stable after surgery. We did not observe any complications during or after surgery. Conclusions: Excision with conjunctival autograft is an effective and safe method of treatment of primary pterygium. This technique has a low incidence of disease recurrence. We did not observe the return of the pathology in any of our patients during the follow-up. It was possible to stabilize or improve the patients' visual functions and refraction. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate a region of interest (ROI) method of analyzing anterior segment optical coherence tomography (AS-OCT) corneal densitometry (CD) in the setting of Descemet membrane endothelial keratoplasty (DMEK) dehiscence.MethodsRetrospective chart review of eyes that underwent (1) DMEK for Fuchs dystrophy (2) between 2018 to 2020 with (3) a partial DMEK dehiscence on AS-OCT, (4) involvement of only one side of the graft, (5) high-quality corneal AS-OCT scan, and (6) location of dehiscence within the central 5.5 mm of the cornea. Image analysis of the ROIs with ImageJ compared the total edematous area, mean stromal CD, and ratio of anterior-to-posterior (A/P) stromal CD for regions of DMEK dehiscence compared to the contralateral side with an attached DMEK graft. Control regions (with no dehiscence) and postdehiscence resolution images were also analyzed.ResultsSeventy sectors of the 21 images from 21 eyes with DMEK dehiscence were included. Compared to the contralateral side, regions of DMEK dehiscence had larger total areas (P < 0.0001), lower mean stromal CD (P = 0.0003), and higher A/P stromal CD (P < 0.0001). All control regions and postdehiscence resolution images did not show any significant differences compared to the contralateral sides.ConclusionsThis technique to analyze multiple ROIs on AS-OCT can be useful to evaluate CD of specific regions of corneal pathology. Lower mean stromal CD and higher A/P stromal CD may specify corneal edema.Translational relevanceAnalyzing CD via multiple specific ROIs may be more suitable than measuring the CD of the full cornea and has broader applications extending to other corneal pathologies.

Background: Swept-source anterior segment optical coherence tomography (SS-AS-OCT) is a suitable examination for the vitreolenticular interface. Methods: In a prospective study using Anterion (Heidelberg Engineering, Heidelberg, Germany), 102 eyes of 102 patients were examined in pupil dilation, preoperatively and 6 times over 1-year follow-up. Preoperatively anterior hyaloid membrane (AHM) visibility was determined with Imaging App with high reliability. Postoperatively capsular bag–AHM distance was measured on six points by using Metrics App. Results: The AHM was visible in 18.6% preoperatively and postoperatively as well (Group 1), 49% of the preoperatively adherent AHMs became visible (Group 2A), 32.4% remained attached (Group 2B). Group 1: the average deepest point on the first day was 782.5 ± 324.1 microns, and it significantly differed from the later follow-up values. Group 2A: the average deepest value was 184.1 ± 220.1 microns, and there was no statistically significant difference between the postoperative visit values. The difference between the groups was statistically significant at every location and at each time point. Conclusions: AS-SS-OCT can be used to check BS both preoperatively (with limitations) and postoperatively.