Spectral Domain Anterior Segment Optical Coherence Tomography in Fungal Keratitis

Purpose: To evaluate the use of spectral domain anterior segment optical coherence tomography (SD-ASOCT) in fungal keratitis. Methods: Fifty eyes of 50 patients with fungal keratitis were recruited. Serial ASOCT was performed on days 0, 7, 14, 21, 28, 42, and 56. Corneal thickness (CT) in the infiltrate area, infiltrate thickness (IT), and infiltrate width were measured at each follow-up. The presence of any specific feature on ASOCT was evaluated. Results: Mean CT and IT at presentation were 650.5 +/- 108 mu m and 401.1 +/- 91 mu m, which reduced significantly at each follow-up [on days 7, 14, 28, and 42; 626.8 +/- 113 mu m (P < 0.001) and 367.3 +/- 94 mu m (P = 0.002), 601.4 +/- 109 mu m and 344.7 +/- 94 mu m (P < 0.001), 544.8 +/- 103 mu m and 305.1 +/- 80 mu m (P < 0.001), and 522.8 +/- 97 mu m and 291.4 +/- 79 mu m (P < 0.001), respectively]. The mean CT and scar depth at complete healing were 496.3 +/- 101 mu m and 283.2 +/- 77 mu m, respectively. In 10/50 (20%) eyes, the posterior border of the cornea was not clearly visible because of posterior shadowing; therefore, IT was measured along the maximum visible area of hyperreflectivity, whereas CT was measured just adjacent to the area of shadowing. The infiltrate width was measured in 35 eyes, and the mean values at days 0, 7, 14, 28, 42, and 56 were 5.5 +/- 0.8 mm, 4.6 +/- 0.7 mm, 4.4 +/- 0.6 mm, 4.2 +/- 0.6 mm, 4.1 +/- 0.6 mm, and 4.1 +/- 0.6 mm, respectively. A satellite lesion and endothelial plaque were seen in 30% (15/50) and 44% (22/50) eyes, respectively. Conclusions: ASOCT is a useful adjunct in monitoring fungal keratitis especially in cases with deep stromal involvement and endothelial plaques. In addition, it also provides insight into the activity of keratitis.