Limbal Vascular Regrowth After Ocular Surface Chemical Injuries: Imaging by Anterior Segment Optical Coherence Tomography Angiography

Objectives: To assess limbal vascular changes 1 year after ocular surface chemical injury using anterior segment optical coherence tomography angiography (AS-OCTA), and to evaluate its potential for guiding long-term clinical management. Methods: This prospective longitudinal study included 10 patients with recent ocular surface chemical injury. All subjects underwent initial and 1-year follow-up evaluations using clinical slit-lamp examination and AS-OCTA imaging. Limbal ischemia was quantified in clock hours from en-face OCTA images and compared with clinical findings. Correlations with visual acuity and Dua classification grades were analyzed. Results: The mean clinically observed limbal ischemia at baseline was 5.5 clock hours, whereas AS-OCTA revealed a broader mean ischemic area of 7 clock hours. At 1-year follow-up, the ischemic areas significantly regressed in both assessments, and AS-OCTA values were closely correlated with final visual acuity (r=0.683). In two severe cases, persistent ischemia and limbal stem cell deficiency were accurately predicted by OCTA. Conclusions: AS-OCTA enables precise, noninvasive quantification of limbal ischemia and may overcome limitations of subjective clinical grading systems. Beyond acute evaluation, it provides insight into revascularization dynamics, supporting more informed decisions on the timing of stem cell transplantation. Anterior segment optical coherence tomography angiography holds strong promise as a standard imaging tool in both acute management and long-term follow-up of chemical ocular injuries.