Observational study compares ASOCT and slit lamp for hypopyon detection in microbial keratitis

Photo by Faustina Okeke / Unsplash

medRxiv Published April 17, 2026 Medically reviewed April 25, 2026 Study authors: Reddy, K. N.; Ibukun, F.; Huang, K.; Yi, J.; Jain, E.; Kuyyadiyil, S.; Parmar, G. S.; Shekhawat, N. … DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider ASOCT for hypopyon detection in microbial keratitis; observational study shows excellent agreement and higher detection rates than SLE.

This observational study compared anterior segment optical coherence tomography (ASOCT) and slit lamp examination (SLE) for hypopyon detection in eyes with microbial keratitis. The authors assessed inter-grader and intra-grader agreement, measurement reproducibility, and detection rates between the two modalities. No medications were evaluated, and safety data were not reported.

Inter-grader agreement for hypopyon detection on ASOCT was excellent (k=0.94, 95% CI 0.84-1.00), with intra-grader agreement also excellent (k=0.89-1.00). Hypopyon detection rates were 67.1% of eyes with ASOCT versus 57.0% of eyes with SLE. When using ASOCT as the reference, sensitivity was 83.0% and specificity was 96.2%.

Measurements of endothelial length and vertical height showed excellent intra-grader reproducibility (ICC 0.977-0.996) and good inter-grader agreement (ICC 0.831 and 0.827, respectively). However, inter-grader bias for vertical height measurement was statistically significant (Wilcoxon p=0.008). Limitations and funding information were not reported.

Because this is an observational study, causal claims cannot be made. The results indicate potential utility of ASOCT for hypopyon detection, but clinical application should consider the study design and lack of reported adverse events.

Study Details

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

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 (k=0.94; 95% CI 0.84-1.00) and intra-grader agreement was excellent (k=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.