Spectral domain optical coherence tomography study of pearl-like lesions in the anterior chamber

Abstract

Aim: To study the morphological pattern of pearl-like lesions in the anterior chambers of children before and after management using anterior segment spectral domain optical coherence tomography (SD-OCT).

Patients and methods: This was a prospective, observational cross-sectional study of patients presenting with peculiar pearl-like lesions in the anterior chamber of their eyes. 1 mL of betamethasone sodium phosphate (2 mg/mL) and betamethasone dipropionate (5 mg/mL) was injected subconjunctivally. Follow-ups of all patients were conducted for a period of 6 weeks. Anterior segment imaging was done using SD-OCT and also photo slit lamp before and after management.

Results: Twelve eyes of 12 patients were included in this study. These patients presented with pearl-like lesions in the anterior chamber with signs of anterior uveitis. There was no history of ocular injury or tuberculosis in any patients. Six weeks after subconjunctival steroid injection, all patients achieved mean best-corrected visual acuity, which changed from 0.2 (range 0.1-0.4) to 0.5 (range 0.4-0.8), and the severity of iritis decreased. SD-OCT showed that the lesions at presentation appeared as a globular noncystic mass attached to the back of the cornea, encroaching on the angle of the eye, and attached to the anterior surface of the iris at some points.

Conclusion: SD-OCT for imaging the anterior segment allowed us to exclude the cystic nature of this pearly lesion. Some similarities may exist between these pearly lesions and superficial phlyctenular keratitis, which may support the immunological and inflammatory origin of these lesions.

Keywords: anterior chamber; anterior segment OCT; pearl-like lesions; phlycten.

Figure 1

(A) The first presentation of a patient of 11 years old with a pearl-like lesion in the anterior chamber (arrow) at 7 o’clock with ciliary injection and a pearshaped pupil; (B) the presentation of the same patient after 6 weeks of treatment by subconjunctival and topical steroids with a decrease in the size of the lesion (arrow) and of the ciliary injection with some old keratic precipitates; and (C) the appearance of a new lesion in the anterior chamber (arrow) at 6 o’clock in the same patient 1 week after resolution of the first pearl-like lesion.

Figure 2

Enlargement and heavy vascularization of one of the treated pearl-like lesions (arrow) six weeks after treatment by subconjunctival and topical steroids. Note: This figure also shows the persistence of the pear-shaped pupil.

Figure 3

Vertical scans of anterior segment SD-OCT images of pearl-like lesion at the anterior chamber at 6 o’clock. Notes: Before treatment, the SD-OCT showed a highly reflective globular noncystic mass attached to the back of the cornea and causing shadowing to the iris tissue behind it. After treatment with subconjunctival and topical steroids, the SD-OCT showed a flat, highly reflective mass closing the angle of the eye and adherent to both the back of the cornea and the front surface of the iris. Abbreviation: SD-OCT, spectral domain optical coherence tomography.

Figure 4

Horizontal scan of anterior segment SD-OCT image of a nontreated pearl-like lesion at the anterior chamber at 6 o’clock showing a highly reflective globular noncystic mass (arrow) attached to the back of the cornea and causing shadowing to the underlying iris. Note: This SD-OCT image also shows highly reflective small masses, that could be keratic precipitates, at the back of the cornea, to the left of previously described lesion. Abbreviation: SD-OCT, spectral domain optical coherence tomography.

Figure 5

(Right) The similarity in location between the phlycten (superficial phlyctenular keratitis; arrow); and (Left) a pearl-like lesion in the anterior chamber (arrow), which may be a form of posterior phlyctenular keratitis. Note: Both conditions can be seen presenting as a grayish-white circumscribed lesion in the vicinity of the limbus.