Purpose To compare hypopyon detection using anterior segment optical coherence tomography (ASOCT) versus slit lamp examination (SLE) in microbial keratitis, and to evaluate intra- and inter-grader agreement for ASOCT hypopyon measurement.

Methods Two masked graders independently evaluated ASOCT images for hypopyon presence or absence in eyes with microbial keratitis, with disagreements resolved by consensus. A subset of hypopyon eyes underwent triplicate height measurement using two methods (endothelial length, vertical height). Cohen’s kappa, intraclass correlation coefficients (ICC), sensitivity, and specificity were calculated comparing diagnostic performance of ASOCT versus SLE.

Results Inter-grader agreement for hypopyon detection on ASOCT was excellent (κ=0.94; 95% CI 0.84–1.00) and intra-grader agreement was excellent (κ=0.89–1.00). ASOCT detected hypopyon in 67.1% of eyes versus 57.0% by SLE (sensitivity 83.0%, specificity 96.2% using ASOCT as reference). Intra-grader reproducibility was excellent for both endothelial length and vertical height measurements (ICC 0.977–0.996). Inter-grader agreement was good for endothelial length (ICC 0.831) and vertical height (ICC 0.827), though a statistically significant inter-grader bias was identified for vertical height only (Wilcoxon p=0.008).

Conclusions ASOCT detected hypopyon with greater sensitivity than SLE and demonstrated excellent intra-grader and good inter-grader measurement reproducibility. Endothelial length showed slightly superior inter-grader concordance to vertical height measurement.

The authors have declared no competing interest.

This work was supported by the National Institutes of Health (K23EY032988 and R33EY034343 to N.S.S.), KeraLink International, and the Stephen F Raab and Mariellen Brickley-Raab Rising Professorship in Ophthalmology. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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The IRB of the Johns Hopkins University School of Medicine gave ethical approval for this work. The ethics committee of SNC Chitrakoot gave ethical approval for this work.

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