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Quantitative analysis of vitreous inflammation using optical coherence tomography in patients receiving sub-Tenon's triamcinolone acetonide for uveitic cystoid macular oedema
  1. Sreekanth Sreekantam1,
  2. Trystan Macdonald2,
  3. Pearse A Keane3,
  4. Dawn A Sim3,
  5. Philip I Murray1,4,
  6. Alastair K Denniston2,4
  1. 1Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
  2. 2Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  4. 4Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Alastair K Denniston, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; a.denniston{at}bham.ac.uk

Abstract

Background/aims To evaluate the vitreous signals obtained on spectral domain optical coherence tomography (SD-OCT) in patients with uveitic cystoid macular oedema (CMO) and compare these signals before and after sub-Tenon's triamcinolone acetonide injection.

Methods Retrospective study with standardised longitudinal imaging preintervention and postintervention. The study cohort comprises 22 patients (22 eyes) with uveitic CMO receiving a sub-Tenon's triamcinolone acetonide (STTA) injection. Post hoc analysis of SD-OCT images using custom software provided an ‘absolute’ measurement of vitreous signal intensity, which was expressed as a ratio to the retinal pigment epithelium intensity (‘VIT/RPE-relative intensity’) in arbitrary units.

Main outcome measure Difference in VIT/RPE-relative intensity before and after treatment.

Results Treatment with STTA resulted in a significant reduction in VIT/RPE-relative intensity, which was associated with both a reduction in central retinal thickness (CRT) and improvement in visual acuity. Mean (SD) VIT/RPE-relative intensity pretreatment was 0.139 (0.074) versus 0.053 (0.028) post-treatment (p=3×10−5). Mean (SD) CRT was 581 μm (119 μm) pretreatment versus 333 μm (95 μm) post-treatment (p=2×10−8); the mean reduction in CRT was 248 (95% CI 189 to 306). The correlation coefficient between VIT/RPE-relative intensity and CRT was 0.534 (p=0.011) and between VIT/RPE-relative intensity and visual acuity was 0.702 (p=0.0001).

Conclusions This study provides evidence that the OCT-derived VIT/RPE-relative intensity may be useful as a quantitative and objective marker of disease activity and treatment response in uveitis complicated by CMO. This first longitudinal study of this novel OCT parameter is an encouraging step in the development of sensitive objective OCT-based endpoints for trials of efficacy in uveitis.

  • Inflammation
  • Imaging
  • Diagnostic tests/Investigation
  • Macula
  • Vitreous

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Footnotes

  • SS and TM contributed equally.

  • Contributors AKD, PAK and PIM designed the study. SS and TM collected and analysed the data along with DAS who also performed statistical review. TM, SS and AKD wrote the manuscript. SS, TM, AKD, PAK, PIM and DAS reviewed the manuscript.

  • Funding AKD has received a proportion of his funding from the following charities: Fight for Sight, the Birdshot Uveitis Society and the Uveitis Information Group (24BU151, 1994, 24UV13).

  • Competing interests PAK and DAS have received a proportion of their funding from the Department of Health's NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. The views expressed in the publication are those of the author and not necessarily those of the Department of Health.

  • PAK and DAS have received travel grants from the Allergan European Retina Panel.

  • Ethics approval UK National Health Service research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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