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Role of anterior segment optical coherence tomography angiography in assessing limbal vasculature in acute chemical injury of the eye
  1. Marcus Ang1,2,3,
  2. Valencia Foo1,
  3. Mengyuan Ke2,
  4. Bingyao Tan2,4,5,
  5. Louis Tong1,2,3,
  6. Leopold Schmetterer1,2,3,4,5,6,7,8,
  7. Jodbhir S Mehta2,3
  1. 1Department of Ophthalmology and Visual Science, Singapore National Eye Centre, Singapore
  2. 2Singapore Eye Research Institute, Singapore
  3. 3Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore
  4. 4SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
  5. 5Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
  6. 6Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
  7. 7Institute of Clinical and Experimental Ophthalmology, Basel, Switzerland
  8. 8Institute for Health Technologies, Nanyang Technological University, Singapore
  1. Correspondence to Dr Marcus Ang, Department of Ophthalmology and Visual Science, Singapore National Eye Centre, Singapore 168751, Singapore; marcus.ang{at}snec.com.sg

Abstract

Purpose To study the role of two anterior segment optical coherence tomography angiography (AS-OCTA) systems in eyes with acute chemical injury.

Methods Prospective study in subjects with unilateral chemical injuries. Sequential slit-lamp assessment with spectral domain (SD) (AngioVue, Optovue, USA) and swept source (SS) (Plex Elite, Zeiss, Carl Zeiss Meditec, Dublin, California, USA) AS-OCTA was performed in both eyes within 24–48 hours of injury. Subjects were managed with a standard clinical protocol and followed-up for 3 months. We assessed limbal disruption (loss of normal limbal vessel architecture), limbal vessel density measurements and agreement (kappa coefficient, κ) between masked assessors of limbal disruption based on AS-OCTA scans and slit-lamp assessment.

Results Ten subjects with median age 31 (25–33) years, 20% women, 60% suffered alkali injuries (Roper-Hall grade 1.5±0.7, Dua grade 2.3±1.2) at presentation. Mean limbal vessel density was lower in quadrants of affected eyes compared with controls detected by SD AS-OCTA (9.4%±2.0% vs 15.5%±1.8%, p<0.001) and SS AS-OCTA (8.8%±2.5% vs 13.9%±1.3%, p=0.01). There was substantial agreement when assessing limbal disruption on AS-OCTA (κ=0.7) compared with slit-lamp evaluation (κ=0.4). Overall, we found good agreement between SD and SS AS-OCTA systems in assessing limbal vessel density in eyes with chemical injury at presentation (mean paired difference: −1.08, 95% CI −3.2 to 0.5; p=0.189).

Conclusions In this pilot study, AS-OCTA provided objective, non-contact, rapid assessment of limbal vasculature involvement in eyes with acute chemical injury. Further studies are required to establish the role of AS-OCTA in determining the prognosis of eyes with chemical injury.

  • cornea
  • angiogenesis
  • imaging
  • ocular surface
  • trauma

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Correction notice This paper has been updated since it was published online. In the previous version the last author's name was transposed and this has now been corrected.

  • Funding Kavya Devarajan for image analysis and statistical support. Singapore National Eye Centre Health Research Education Fund, National Medical Research Council (grants CG/C010A/2017, OFLCG/004C/2018 and TA/MOH-000249-00/2018).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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