Anterior Segment Optical Coherence Tomography Epithelial Thickness Mapping for Lesion Delineation in Recurrent Corneal Erosion: A Paired-Method Study.

PURPOSE: To investigate disparities in lesion areas measured using external eye photography with corneal fluorescein staining (CFS) and anterior segment optical coherence tomography (AS-OCT)-based corneal epithelial thickness (CET) mapping in recurrent corneal erosion (RCE), aiming to provide a basis for laser and surgical planning.

METHODS

Fifteen RCE patients underwent same-day external eye photography and AS-OCT. CFS lesions were manually delineated, and CET lesions were identified by marking regions with a thickness ≥ 60 µm. The two methods were compared retrospectively. Patients with extensive CET mapping-identified lesions underwent phototherapeutic keratectomy (PTK) after manual epithelial debridement, with clinical outcomes and CET map findings evaluated.

RESULTS

The lesion area defined by CET mapping was significantly larger than that measured by CFS, with a significant median difference of 9.26 mm2 (95% confidence interval [CI], 5.87-14.42; P < 0.0001). Although the two methods were strongly correlated (r = 0.904; P < 0.0001), Bland-Altman analysis revealed a consistent mean bias. In 10 cases where CFS revealed only inferior involvement, CET mapping detected superior extension in five eyes, enhancing treatment planning accuracy. PTK was performed on nine patients, with no recurrences occurred (1 loss to follow-up). Smooth corneal epithelium with normalized thickness were observed in CET maps at a median of 7 months (range, 3-10; n = 5).

CONCLUSIONS

CET mapping is a sensitive and reliable tool for detecting larger lesion areas in RCE compared to CFS, enabling more accurate treatment planning and improved management outcomes.

TRANSLATIONAL RELEVANCE: AS-OCT-based corneal epithelial thickness mapping can refine clinical decision-making by revealing subclinical epithelial changes, supporting personalized treatment strategies for RCE.