Using anterior segment optical coherence tomography to assess the anterior chamber cells among patients with anterior uveitis

Purpose To investigate the potential utility of anterior chamber (AC) cell measurement in uveitis patients using anterior segment optical coherence tomography (AS-OCT). Patients and methods This prospective case–control study included 100 eyes: group A (cases) included 50 eyes with clinically active anterior uveitis (grade 1 or more) and group B (controls) included 50 patients who are inactive uveitis cases (grade 0) or minimally active disease (grade +0.5) recruited at Menoufia University Hospital between July 2024 and July 2025. All participants underwent comprehensive ophthalmic evaluation, including best-corrected visual acuity and AC cell grading by the standardization of uveitis nomenclature system using slit-lamp biomicroscopy. AC imaging was performed with Zeiss CIRRUS 6000 AS-OCT, and hyperreflective cellular spots were quantified. Laboratory investigations and systemic workup were performed to determine underlying etiology. Results Among 50 uveitis cases, idiopathic etiology was most common (66%), followed by granulomatous (20%) and nongranulomatous causes (14%). OCT detected higher mean AC cell counts (21.3±14.4) compared with slit-lamp biomicroscopy (10.8±11.8), with a significant mean difference (10.5±19.6, P =0.001). OCT grading revealed more frequent detection of moderate inflammation (grades 2–3), whereas slit-lamp grading clustered in lower categories (grades 0.5–1). Conclusions AS-OCT demonstrated superior sensitivity and quantitative precision in detecting AC inflammatory cells compared with slit-lamp biomicroscopy. By providing objective and reproducible measurements, OCT may enhance monitoring of disease activity and therapeutic response in anterior uveitis, complementing conventional clinical grading.