Advanced UltraTech approach for distinguishing granulomatous from non-granulomatous corneal endothelial exudates in autoimmune rheumatic anterior uveitis

Abstract

Background: Anterior uveitis is a common manifestation in individuals with rheumatic conditions such as spondylarthritis, Behçet’s syndrome, juvenile idiopathic arthritis, and sarcoidosis. Clinical differentiation between granulomatous and non-granulomatous corneal endothelial exudates is crucial to subsequent diagnosis and treatment. Anterior segment optical coherence tomography (AS-OCT) can ensure an accurate differential diagnosis and appropriate follow-up after local and systemic therapy. Objective: This study aimed to distinguish between granulomatous and non-granulomatous endothelial exudates in patients with anterior uveitis using AS-OCT. Methods: This longitudinal observational study involved 30 patients diagnosed with or suspected of having rheumatic autoimmune disease presenting with anterior uveitis. The study was conducted at the combined Rheumatology and Ophthalmology Clinic, San Marco Hospital, Catania, Italy. All patients underwent slit-lamp examination, which revealed or suspected corneal endothelial exudates. A comprehensive rheumatological and ophthalmological evaluation was also performed. Subsequently, the patients were subjected to AS-OCT using the Optovue Solix device. Results: Granulomatous corneal exudates were identified in 30% of the subjects, with counts ranging from 5 to 20 and sizes varying between 50 and 150 μm. Detailed 3D scans further exhibited the morphology of these exudates. A follow-up of patients after steroid therapy (both topical and systemic) and immunosuppressive treatment demonstrated a progressive reduction in the exudates, ultimately leading to their complete resolution. Conclusion: Use of ophthalmological equipment that allows for simple, rapid, and non-invasive investigations in combination with a multidisciplinary approach, enables appropriate diagnosis and monitoring of therapeutic efficacy in patients with inflammatory ocular conditions presenting with corneal endothelial exudates.