A modern approach to diagnostic methods of the cornea and aqueous humor of anterior chamber of the eye in patients with anterior uveitis, associated with spondyloarthritis

Abstract

Anterior uveitis is the dominant clinical extra-articular manifestation of spondyloarthritis associated with the carriage of the human leukocyte antigen allele (HLA-B27), which may precede joint and spinal involvement. In 20–30% of cases, uveitis occurs with frequent relapses – up to 5–6 exacerbations per year, often has a protracted character and is poorly amenable to local anti-inflammatory therapy, which leads to a decrease in vision and a deterioration in the quality of life. Timely and accurate assessment of the severity of intraocular inflammation plays an important role in making a diagnosis and in choosing the right treatment tactics for treating anterior uveitis in patients with HLA-B27-associated spondyloarthritis. The current standard clinical approach to assessing inflammation is the presence and number of inflammatory cells in the anterior chamber aqua humor according to the SUN classification using slit lamp imaging. However, the assessment of SUN is very subjective. Moreover, the individual variability in anterior chamber cell count, which is the main diagnostic criterion for uveitis, can be exacerbated by certain testing conditions, such as the brightness of the slit lamp light bar, light beam size calibration, light source intensity. Advances in optical imaging technology, the application of the latest technologies and the improvement of already known methods offer new opportunities for an objective, accurate and quantitative assessment of inflammation. The article describes the possibilities of studying the cornea and the anterior chamber of the eye using anterior segment optical coherence tomography, confocal microscopy of the cornea and keratotopometry.