Use Of High Resolution Anterior Segment Oct And Confocal Corneal In-Vivo Microscopy For Difficult Cases

We wish to present 3 very difficult patients that were seen for 2nd opinion at our university eye hospital. With the use of advanced non-invasive anterior segment imaging techniques we found their diagnosis and directed the course of their treatment. Multimodal imaging is key for decision making in these cases. 

Universty eye hospital Svjetlost, Zagreb, Croatia

All patients were imaged on CSO Anterior Segment OCT and Heidelberg HRT3 with Rodenstock Cornea Module. We wish to present 3 cases, KB - a patient who had metallic dust particles from a PRK cannula in his stroma for 3 years. MD - a patient who had fungus infection on top of a HSV-1 infection that was not found before usage of confocal microscopy and MK who had a lesion suspected to be carcinoma, using confocal microscopy we excluded the possibility of carcinoma.

For KB after we found the metallic dust particles we used a mix of steroids, cyclosporine and NSAIDs his condition was resolved within 8 months and he is now pain free.

For MD using confocal microscopy we found that he had a dual infection, fungus hyphae were found on confocal microscopy and Voriconazole was started. He has now been clear from flare ups and off acyclovir for months. AS-OCT was used to monitor the progress of the treatment.

For MK using confocal microscopy and AS-OCT we confirmed the lesion to be episcleritis and not a malignant lesion. During the confocal investigation we observed multiple cell types and RBC flow on video.

Advanced imaging techniques can help reach a diagnosis and direct better treatment for patients that were previously considered as untreatable.