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Evaluation of vascular changes in intermediate uveitis and retinal vasculitis using swept-source wide-field optical coherence tomography angiography
  1. Meng Tian1,
  2. Christoph Tappeiner1,
  3. Martin S Zinkernagel1,
  4. Wolfgang Huf2,3,
  5. Sebastian Wolf1,4,
  6. Marion R Munk1,4
  1. 1 Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  2. 2 Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
  3. 3 Department of Laboratory Medicine, Hietzing Hospital, Vienna, Austria
  4. 4 Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Marion R Munk, Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland; marion_munk{at}hotmail.com

Abstract

Purpose To evaluate vascular changes in patients with intermediate uveitis with or without retinal vasculitis using swept-source wide-field optical coherence tomography angiography (OCTA).

Methods This is a prospective cross-sectional study. Consecutive patients with intermediate uveitis were evaluated using wide-field OCTA. Wide-field OCTA and en-face OCT images were analysed for the presence of capillary non-perfusion and reduced perfusion, disruption of ellipsoid zone, and abnormalities on en-face wide-field retinal thickness maps, respectively, and compared with fluorescein angiography (FA) findings in a subcohort.

Results 164 eyes of 88 patients with intermediate uveitis were included. Areas of capillary non-perfusion and reduced perfusion were more frequently observed in the choroidal OCTA slab (33.3% and 49.4%), choriocapillaris (CC; 31.4% and 48%) and deep capillary plexus (DCP; 9.6% and 34.6%) than in the superficial capillary plexus (SCP; 5% and 26.3%), respectively. Intermediate uveitis with vasculitis presented more frequently with non-perfusion and hypoperfusion in the DCP (p=0.003 and p=0.05, respectively) and SCP (p=0.007 and p=0.005, respectively) than intermediate uveitis without vasculitis. Peripheral capillary leakage on FA correlated with the presence of perivascular, macular and generalised thickening on en-face wide-field thickness maps (p=0.007). Ischaemia on FA was significantly associated with non-perfusion on wide-field OCTA in SCP and DCP (p=0.019 and p=0.027, respectively).

Conclusion Changes in the choroid, CC and DCP are more frequently found than in the SCP on wide-field OCTA in intermediate uveitis. While wide-field OCTA is a reliable tool to detect capillary non-perfusion in intermediate uveitis, it was not helpful in determining disease activity.

Trial registration number NCT02811536.

  • intermediate uveitis
  • retinal vasculitis
  • optical coherence tomography angiography (OCTA)
  • fluorescein angiography

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors MT: analysis of data, evaluation of data, writing the manuscript. TC: collecting data, critical review of the paper. MSZ: collecting data, evaluation of data, critical review of the paper. WH: statistical analysis, critical review of the paper. SW: financial support, collecting data, critical review of the paper. MRM: study design, analysis and evaluation of data, statistical analysis, critical review of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer MT: none. TC: consultant: AbbVie. WH: none. MRM: consultant: Novartis, Zeiss, GenSight Biologics and LumiThera; lecturer fees and travel support: Bayer. SW: consultant: Novartis, Zeiss, Heidelberg and Bayer. MSZ: consultant: Novartis, Heidelberg and Bayer; stocks: Novartis.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study was approved by the University Clinic Bern IRB and followed the tenets of the Declaration of Helsinki.

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

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