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Wipada Laovirojjanakul, Nisha Acharya, John Alexander Gonzales; Ultra-Widefield Fluorescein Angiography in Intermediate Uveitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3413.
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Ultra-widefield fluorescein angiography (UWFFA) in intermediate uveitis often reveals vascular leakage that is not clinically detectable. We describe patterns of vascular leakage using UWFFA and correlate these findings with clinical manifestations of inflammation in intermediate uveitis.
We performed a retrospective review of 24 patients with intermediate uveitis who had UWFFA performed at a single tertiary referral center, The Francis I. Proctor Foundation, between July 2014 and July 2015. The main outcome was the pattern of retinal vascular leakage on UWFFA, which was classified as being anterior or posterior to the equator, or both. Visual acuity (VA), inflammation on exam and CME was also assessed. The association between activity level and location of leakage on UWFFA was assessed by using the chi-squared test.
A total of 41 eyes from 24 patients were included, of which 31 eyes (76%) displayed active inflammation and 10 eyes displayed inactive inflammation (24%).We identified 2 patterns of vascular leakage: 1) anterior to the equator (12 eyes, 29%) and 2) posterior and anterior to the equator (26 eyes, 63%). No eyes exhibited leakage posterior to the equator alone. Of the 31 eyes with active inflammation 21 (77%) had posterior and anterior leakage while 7 eyes (23%) had leakage anterior to the equator alone. Of the 10 clinically inactive eyes 2 (20%) had posterior and anterior leakage, 5 eyes (50%) had anterior leakage alone, and 3 eyes (30%) had no leakage. Of the 10 eyes that were clinically inactive, 2 eyes (20%) exhibited posterior and anterior leakage There 5 eyes (50%) with anterior leakage alone. All of these eyes had VA better than 20/40. Three eyes (30%) did not have any leakage on UWFFA. We found a statistically significant difference in the number of the patients with active inflammation demonstrating leakage on UWFFA compared to patients with inactive leakage (p = 0.012).
We identify leakage on UWFFA not appreciated on clinical examination. Given that the current classification criteria considers intermediate uveitis to have inflammation in the vitreous which may be accompanied by leakage of the peripheral retinal vasculature, consideration for revision to the nomenclature for intermediate uveitis exhibiting vascular leakage posterior to the equator should be considered. The clinical significance of leakage anterior to the equator remains to be determined.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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