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Comparing optical coherence tomography findings in different aetiologies of infectious necrotising retinitis
  1. Alessandro Invernizzi1,2,
  2. Aniruddha Kishandutt Agarwal3,
  3. Vittoria Ravera1,
  4. Chiara Mapelli4,
  5. Agostino Riva5,
  6. Giovanni Staurenghi1,
  7. Peter J McCluskey2,
  8. Francesco Viola6
  1. 1Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
  2. 2Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, Australia
  3. 3Advanced Eye Center - Postgraduate Institute of Medical Education and Research, Chandigarh, India
  4. 4Fatebenefratelli and Ophthalmic Hospital, Azienda SocioSanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milano, Italy
  5. 5Department of Clinical Sciences, Luigi Sacco Hospital, Section of Infectious and Tropical Diseases, University of Milan, Milan, Italy
  6. 6Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
  1. Correspondence to Dr Alessandro Invernizzi, Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Luigi Sacco Hospital, University of Milan, Milan 20157, Italy; alessandro.invernizzi{at}gmail.com

Abstract

Aims To compare optical coherence tomography (OCT) features of active necrotising infectious retinitis (NIR) due to toxoplasmosis or herpesviruses and to determine distinctive OCT signs for these two causes of infectious retinitis.

Methods OCT scans from eyes with active NIR due to varicella zoster virus (VZV), herpes simplex virus (HSV), cytomegalovirus (CMV), and toxoplasmosis (TOXO) were reviewed. All images were evaluated for the presence of previously described OCT findings in TOXO-NIR and compared with the viral group. New OCT findings were recorded and compared. Retinal and choroidal thickness were measured at the site of NIR and compared.

Results 10 eyes diagnosed with TOXO-NIR and 13 eyes affected by viral-NIR (9 CMV and 4 VZV) were analysed. All eyes showed full thickness hyper-reflectivity, disruption of the retina and a variable degree of vitritis. Among previously described OCT signs, hyper-reflective oval deposits and hypo-reflectivity of the choroid had a higher prevalence in TOXO (p=0.018 and p<0.0001, respectively). Among the new signs, hyper-reflective round deposits along the posterior hyaloid, retrohyaloid hyper-reflective spots and a disruption of the choroidal architecture were more frequent in TOXO eyes (all p<0.01). Intra-retinal oedema and hyper-reflective vertical strips within the outer nuclear layer were suggestive of a viral aetiology (p=0.045). Retinal thickness at the site of NIR did not differ between the two groups. Choroidal thickness was significantly higher in TOXO eyes (p=0.01).

Conclusions The diagnosis of NIR is largely based on clinical and laboratory findings. OCT changes may be useful in differentiating different causes of NIR.

  • imaging
  • infection
  • inflammation
  • retina

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Footnotes

  • Contributors AI: designed the work, acquired, analysed and interpreted the data, drafted the work, revised and gave final approval. AA: analysed and interpreted the data, drafted the work, revised and gave final approval. VR, CM, AR: acquired, analysed and interpreted the data, revised and gave final approval. GS, FV, PMC: interpreted the data, revised and gave final approval.

  • Competing interests GS has financial relations with OCT manufacturers including: Heidelberg Engineering, Zeiss, Nidek, Canon, Optovue.

  • Ethics approval Local IRB.

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

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