Anterior Segment Optical Coherence Tomography in Uveitis: Current Applications and Future Directions

Abstract

Anterior segment optical coherence tomography (AS-OCT) is a non-invasive imaging modality providing high-resolution images of anterior ocular structures, aiding morphological assessments and biomarker identification in uveitis management. This chapter examines AS-OCT’s clinical and investigational roles in uveitis, detailing its utility in detecting subtle corneal changes, keratic precipitate (KP) morphology, anterior chamber cells, and iris structural alterations. AS-OCT facilitates longitudinal monitoring of anterior uveal inflammation, mirroring histopathological changes in vivo. It distinguishes granulomatous from non-granulomatous KPs, supports evaluation of infectious uveitis subtypes, and assesses angle structures for trabeculitis or synechiae-related glaucoma. Pre- and post-cataract surgery assessments in complex uveitic cases benefit significantly from AS-OCT, aiding differentiation of conditions such as Posner-Schlossman syndrome and Fuchs’ uveitis syndrome via iris morphology analysis. Despite its advantages, AS-OCT faces technical limitations, including suboptimal visualization of iris, posterior chamber, ciliary body, and middle segment—though this can be partially addressed using contact lens-assisted imaging—difficulty differentiating inflammatory cells from pigment or debris, and susceptibility to artifacts. Emerging innovations like spectroscopic OCT (SOCT) for molecular profiling, pseudocolor segmentation, adaptive optics OCT (AO-OCT), and robotic-assisted imaging promise artifact-free acquisition and enhanced resolution. Integration with complementary technologies like laser flare photometry (LFP), ultrasound biomicroscopy (UBM), confocal microscopy, and radiomics-based AI analytics strengthens multimodal imaging approaches. Advancing these combined modalities promotes standardized diagnostics, biomarker development—including molecular, cellular, and structural biomarkers—and fully automated, precision-driven uveitis care.