Semi-Automated Analysis of Anterior Chamber Inflammation by Spectral-Domain Optical Coherence Tomography in Cataract Surgery Patients

To determine the feasibility of using anterior segment optical coherence tomography (AS-OCT) to image and objectively quantify anterior chamber (AC) inflammation after cataract surgery. Prospective case series of patients who underwent cataract surgery by one surgeon at a single academic center. AC volume scans were obtained using AS-OCT (Avanti, Optovue Inc, Fremont, CA) at postoperative day 0 or 1 (POD0/1), postoperative week 1 (POW1), and postoperative month 1 (POM1) after cataract surgery. AS-OCT images were analyzed by a semi-automated algorithm, which identified AC hyper-reflective spots. 155 eyes from 117 patients who underwent cataract surgery were included. The average patient age was 69.2 years (range: 44-91 years). The average fluid density (spots per mm3) was 51.52 at POD0, 26.81 at POD1, 5.15 at POW1, and 1.78 at POM1. The average fluid density correlated with clinical grading of masked uveitis specialists but not with grading of the cataract surgeon. Brown irises had significantly higher average fluid density compared to blue at POW1 (4.47 ± 8.87 vs. 2.11 ± 1.80, p = 0.04) and POM1 (2.01 ± 3.50 vs. 0.75 ± 0.72, p = 0.01). A significant difference was noted in average fluid density between uveitic and non-uveitic eyes at POD0/POD1 (19.4 ± 16.1 vs. 46.9 ± 70.1, p < 0.001). Femtosecond laser-assisted surgery eyes had significantly lower average fluid density compared to traditional cataract surgery eyes at POM1 (0.66 ± 0.55 vs. 2.11 ± 5.77 spots/mm3, p = 0.02). AS-OCT can be used to grade AC inflammation in cataract surgery patients and may be more reliable compared to clinical grading. Further investigation of this technology in larger, multi-institutional cohorts is warranted.