Abstract
PURPOSE: To evaluate the diagnostic and surgical relevance of anterior segment optical coherence tomography (AS-OCT) in granular, lattice and macular corneal dystrophies in Romania, and to illustrate key imaging features using cases from our centre. METHODS: We searched the PubMed/MEDLINE database for articles published between January 2010 and January 2025 using combinations of the following terms "granular corneal dystrophy", "lattice corneal dystrophy", "macular corneal dystrophy" with "anterior segment optical coherence tomography". We excluded studies that contained no anterior segment optical coherence tomography data. We prioritised peer-reviewed original articles and systematic reviews. Given the rare nature of these dystrophies, case reports were included if they contained relevant AS-OCT data. Representative slit-lamp and AS-OCT images from our clinic were included to contextualize findings. RESULTS: Stromal dystrophies are rare in Romania and their overlapping clinical features make diagnosis difficult. Anterior segment optical coherence tomography helps by offering depth-resolved visualization of epithelial, Bowman's layer and stromal changes. It allows more reliable differentiation between entities: granular dystrophy shows sharply defined hyperreflective deposits; lattice dystrophy shows linear, branching stromal amyloid; and macular dystrophy shows diffuse stromal hyperreflectivity with associated thinning. These layer-specific patterns improved phenotypic differentiation and, in surgical candidates, helped estimate lesion depth and residual clear stroma, thereby informing the choice of keratoplasty technique and postoperative monitoring. CONCLUSIONS: Anterior segment optical coherence tomography refines diagnosis, enhances early detection and guides surgical decision-making in stromal corneal dystrophies. Its objective imaging markers facilitate monitoring of disease progression and postoperative recurrence. Continued advances in multimodal imaging and automated analysis are expected to further strengthen its role in personalised management.