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

Wael Soliman^*, Ehab I Wasfi^*, Omar M Ali

Department of Ophthalmology, Assiut University Hospital, Assiut University, Assiut, Egypt

^*These authors contributed equally to this work

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: pearl-like lesions, anterior chamber, phlycten, anterior segment OCT