Role of anterior segment optical coherence tomography angiography in assessing limbal vasculature in acute chemical injury of the eye

Purpose To study the role of two anterior segment optical coherence tomography angiography (AS-OCTA) systems in eyes with acute chemical injury. Methods Prospective study in subjects with unilateral chemical injuries. Sequential slit-lamp assessment with spectral domain (SD) (AngioVue, Optovue, USA) and swept source (SS) (Plex Elite, Zeiss, Carl Zeiss Meditec, Dublin, California, USA) AS-OCTA was performed in both eyes within 24-48 hours of injury. Subjects were managed with a standard clinical protocol and followed-up for 3 months. We assessed limbal disruption (loss of normal limbal vessel architecture), limbal vessel density measurements and agreement (kappa coefficient, kappa) between masked assessors of limbal disruption based on AS-OCTA scans and slit-lamp assessment. Results Ten subjects with median age 31 (25-33) years, 20% women, 60% suffered alkali injuries (Roper-Hall grade 1.5 +/- 0.7, Dua grade 2.3 +/- 1.2) at presentation. Mean limbal vessel density was lower in quadrants of affected eyes compared with controls detected by SD AS-OCTA (9.4%+/- 2.0% vs 15.5%+/- 1.8%, p<0.001) and SS AS-OCTA (8.8%+/- 2.5% vs 13.9%+/- 1.3%, p=0.01). There was substantial agreement when assessing limbal disruption on AS-OCTA (kappa=0.7) compared with slit-lamp evaluation (kappa=0.4). Overall, we found good agreement between SD and SS AS-OCTA systems in assessing limbal vessel density in eyes with chemical injury at presentation (mean paired difference: -1.08, 95% CI -3.2 to 0.5; p=0.189). Conclusions In this pilot study, AS-OCTA provided objective, non-contact, rapid assessment of limbal vasculature involvement in eyes with acute chemical injury. Further studies are required to establish the role of AS-OCTA in determining the prognosis of eyes with chemical injury.