Advantages of Anterior Segment Optical Coherence Tomography Evaluation of the Kayser–Fleischer Ring in Wilson Disease

Purpose To present anterior segment optical coherence tomography (AS-OCT) findings of the Kayser-Fleischer (KF) ring in Wilson disease (WD) and to discuss the potential advantages of evaluating the KF ring by AS-OCT. Methods This is a retrospective case series of 7 patients with WD with KF rings seen in our institute during the study period (August 2015 to June 2016). All patients underwent slit-lamp examination of the cornea and AS-OCT (Optovue RTVue Premier). In 2 patients, the length of the KF ring was measured using the gray scale of AS-OCT. Results The KF ring on the gray scale of AS-OCT was visualized as a hyperreflective deep corneal layer at the level of Descemet membrane in all eyes. The OCT color scale revealed the KF ring as a greenish, greenish-yellow, yellow, or yellow-orange band. The gray scale of AS-OCT could easily measure the length of the KF ring in patients 6 and 7. Conclusions AS-OCT is an alternative method of evaluating the KF ring in WD, which can be used in combination with slit-lamp examination. The KF ring can be easily measured using the gray scale of AS-OCT. Further studies are required to study the potential advantages of AS-OCT including assessing the density of the KF ring, as a tool to assess response to treatment in WD, in differentiating the KF ring of WD disease from copper deposits in other situations and pigmented corneal rings in non-Wilsonian liver disease.