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Anterior segment spectral domain optical coherence tomography imaging of patients with anterior scleritis

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Abstract

The purpose of the study was to describe the findings seen on anterior segment spectral domain optical coherence tomography (SD-OCT) in patients with anterior scleritis and determine the feasibility of using SD-OCT to image and grade the degree of scleral inflammation and monitor response to treatment. All patients underwent slit lamp examination by a uveitis specialist, and the degree of scleral inflammation was recorded. Spectral domain OCT imaging was then performed of the conjunctiva and scleral tissue using a standardized acquisition protocol. The scans were graded and compared to clinical findings. Twenty-eight patients with anterior scleritis and ten patients without ocular disease were included in the study. Seventeen of the scleritis patients were followed longitudinally. Common findings on SD-OCT in patients with active scleritis included changes in hyporeflectivity within the sclera, nodules, and visible vessels within the sclera. There was significant variation in findings on SD-OCT within each clinical grade of active scleritis. These changes on SD-OCT improved with treatment and clinical improvement. SD-OCT imaging provided various objective measures that could be used in the future to grade inflammatory activity in patients with anterior scleritis. Longitudinal imaging of patients with active scleritis demonstrated that SD-OCT may have great utility in monitoring response to treatment.

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Authors and Affiliations

  1. Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave i32, Cleveland, OH, 44195, USA

    Ashleigh L. Levison, Careen Y. Lowder, Kimberly M. Baynes, Peter K. Kaiser & Sunil K. Srivastava

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  1. Ashleigh L. Levison
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  2. Careen Y. Lowder
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  3. Kimberly M. Baynes
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  4. Peter K. Kaiser
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  5. Sunil K. Srivastava
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Correspondence to Ashleigh L. Levison.

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Conflicts of Interest

Ashleigh L. Levison: None; Careen Lowder: Santen (C), Clearside (C); Kimberly Baynes: None; Peter K Kaiser: Bayer (C), Regeneron (C), Genentech (C), Novartis (C), Kanghong (C), Ohr Pharmaceuticals (C), Ophthotech (C), Clearside (C), Aerpio (C), Allegro (C); Sunil K. Srivastava: Regeneron (C), Bausch and Lomb (C,FS), Clearside (C,FS), Novartis (FS), Allergan (FS), Carl Zeiss Meditec (C), Santen (C).

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Supplemental Fig. 1

a An OCT of a patient with active scleritis before instillation of 10 % Phenylephrine. Both superficial (arrows) and deep hyporeflective spaces can be seen which represent dilated blood vessels. b After instillation of 10 % Phenylephrine the superficial vessels that were previously marked by arrows resolved. Supplementary material 1 (TIFF 26330 kb)

Supplemental Fig. 2

a Clinical photograph of area of scleromalacia where there is concern for possible full thickness breakdown with exposure of uvea. b OCT confirms there is a thin layer of epithelium protecting the underlying choroid. Supplementary material 2 (TIFF 26330 kb)

Supplemental Video 1

The Optovue OCT system allows for the ability to obtain en face imaging. En face imaging produces a scan of the conjunctiva, tenon’s, episclera, and sclera at each successive depth. The round hyporeflective spaces seen on the raster line scans can be tracked deeper into the tissue imaged. In the upper left of the image the en face image is provided which shows a significant number of blood vessels. The video shown inferiorly has that corresponding level from the en face image demarcated by red lines. This shows that the hyporeflective spaces are consistent with blood vessels and are located deep within the tissue imaged. Supplementary material 3 (AVI 146270 kb)

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Levison, A.L., Lowder, C.Y., Baynes, K.M. et al. Anterior segment spectral domain optical coherence tomography imaging of patients with anterior scleritis. Int Ophthalmol 36, 499–508 (2016). https://doi.org/10.1007/s10792-015-0153-8

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  • DOI: https://doi.org/10.1007/s10792-015-0153-8

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