Evaluation of vascular changes in intermediate uveitis and retinal vasculitis using swept-source wide-field optical coherence tomography angiography

Meng Tian, Christoph Tappeiner, Martin S Zinkernagel, Wolfgang Huf, Sebastian Wolf, Marion R Munk, Meng Tian, Christoph Tappeiner, Martin S Zinkernagel, Wolfgang Huf, Sebastian Wolf, Marion R Munk

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.

Keywords: fluorescein angiography; intermediate uveitis; optical coherence tomography angiography (OCTA); retinal vasculitis.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Non-perfusion (white arrow) and reduced perfusion (yellow triangle) in the montage scans. (A) Superficial capillary plexus, (B) deep capillary plexus, (C) choriocapillaris and (D) choroid.
Figure 2
Figure 2
Disruption (=hyporeflectivity) on the ellipsoid zone of the en-face wide-field slabs. White arrows depict exemplary areas of ellipsoid zone disruption.
Figure 3
Figure 3
Example of colour-coded en-face wide-field retinal thickness map.
Figure 4
Figure 4
En-face wide-field thickness maps. (A) Normal, (B) macular thickening, (C) peripapillary thickening, (D) perivascular thickening and generalised thickening, and (

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