Comparative analysis of pachymetry and assessment of corneal topography in pediatric congenital corneal opacities: A study of AS-OCT and UBM imaging modalities

This study aimed to assess the interchangeability of pachymetry measurements obtained by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in children with congenital corneal opacity (CCO). In this single-centre, comparative case series, children with unilateral or bilateral CCO who underwent examination under anesthesia (EUA) were evaluated using both AS-OCT and UBM. Pachymetry values from both modalities were compared using Bland-Altman analysis, and topography maps from AS-OCT were examined. A total of 54 eyes from 34 children (16 males, 18 females) were included. The mean age at first EUA was 263.93 ± 348.98 days (range: 11 days to 4 years). Mean pachymetry was 785.83 ± 23 μm with UBM and 719.80 ± 247 μm with AS-OCT, showing a statistically significant mean difference of 66.04 ± 133.55 μm (P = 0.0006). UBM consistently yielded higher measurements, and Bland-Altman analysis indicated poor agreement between the two devices. The findings suggest that AS-OCT and UBM are not interchangeable for pachymetry assessment in CCO. However, AS-OCT, being non-contact and usable without sedation, provides practical advantages for longitudinal follow-up and also offers topographic imaging, making it a useful tool in pediatric corneal evaluation.