Researchers recently used anterior segment OCT (AS-OCT) to evaluate corneal perforations and discovered the tool could help reveal subtle leakage. Non-traumatic corneal perforations may present with either a shallow/flat or a formed anterior chamber, the researchers note. While it came as little surprise that flat/shallow anterior chambers had direct leakage, the investigators were pleased to realize AS-OCT could detect the indirect leakage possible with well-formed anterior chambers,

The study included 14 eyes of 13 patients, all of whom had confirmed anterior chamber leakage with a positive Seidel’s sign. The patients had high-resolution AS-OCT scans at multiple time points, which were then analyzed by two independent observers. The researchers compared more than 2,500 AS-OCT sections and anterior segment photographs with each patient’s clinical features and diagnoses.

The team discovered that the group with the formed anterior chambers had hydration of the cornea with lamellar separation of the stroma, intrastromal pockets of fluid, epithelial bullae and an indirect communication between the anterior chamber and the exterior.

In the shallow/flat anterior chamber group, corneal hydration was less obvious and there were no pockets of intrastromal fluid, no epithelial bullae and there was direct communication between the anterior chamber and the exterior.

After gluing, the investigators observed the resolution of the stromal hydration and healing beneath the glue. They also noted the glue and corneal blood vessels consistently cast a dense shadow posteriorly on AS-OCT imaging.

AlMaazmi A, Said DG, Messina M, et al. Mechanism of fluid leak in non-traumatic corneal perforations: an anterior segment optical coherence tomography study. Br J Ophthalmol. December 10, 2019. [Epub ahead of print].