June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Optical Coherence Tomography Angiography Assessment Of Choriocapillaris Ischemia In Ampiginous And Serpigenous Choroidits And Its Response To Treatment
Author Affiliations & Notes
  • Dilraj Singh Grewal
    Ophthalmology, Duke University, Durham, North Carolina, United States
    Moorfields Eye Hospital, London, United Kingdom
  • Sophia L Zagora
    Moorfields Eye Hospital, London, United Kingdom
  • Susan Lightman
    Moorfields Eye Hospital, London, United Kingdom
  • Oren Tomkins-Netzer
    Moorfields Eye Hospital, London, United Kingdom
  • Footnotes
    Commercial Relationships   Dilraj Grewal, Allergan (C); Sophia Zagora, None; Susan Lightman, None; Oren Tomkins-Netzer, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 500. doi:
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      Dilraj Singh Grewal, Sophia L Zagora, Susan Lightman, Oren Tomkins-Netzer; Optical Coherence Tomography Angiography Assessment Of Choriocapillaris Ischemia In Ampiginous And Serpigenous Choroidits And Its Response To Treatment. Invest. Ophthalmol. Vis. Sci. 2017;58(8):500.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To analyze the vascular alterations in the choriocapillaris (CC) using Optical Coherence Tomography Angiography (OCTA) in patients with Ampiginous and Serpigenous choroidits and assessed the reversibility of CC ischemia in response to treatment.

Methods : Retrospective review of new and established inflammatory ampigenous Choroidtiis (n=3) and Quantiferon Gold Positive (QGold) serpignenous choroiditis (n=6) patients who underwent multimodal imaging with OCTA (6x6 mm scan section, Zeiss Angioplex, Carl Zeiss Meditec or Optovue RTVue XR Avanti; Optovue, Inc.), fundus autofluorescence (FAF), fluorescein angiography and indocyanine green angiography (ICG) where available. CC morphological changes visualized on OCTA were overlaid on ICG and FAF images. Areas of CC ischemia (defined as loss of speckled hyperreflectance homogeneity or dark defects not compatible with artifact) were calculated prior to and following treatment.

Results : Fourteen eyes of 9 patients (mean age 41.5±5.6 years) were included. Mean baseline VA was 0.36±0.45 logMAR. Among treated patients there was a reduction in choriocapillaris ischemia from 3.7±1.59 mm2 at presentation to 1.39±2.05 mm2 (p=0.06) following 2.5±2 weeks of oral steroids (1mg/kg). Concurrent anti-TB treatment was initiated in eyes with QGold serpigenous choroiditis. The areas of decreased flow on CC colocalized with areas of hypofluoresence on ICG and were larger than the corresponding areas of hyperautofluorescence on FAF. CC alterations ranged from localized CC ischemia on acute presentation (n=5) to large areas of extensive loss of CC with deeper choroidal vessels visible in longstanding disease (n=4). The superficial migration of larger choroidal vessels to the CC slab level was measured by the increased (83.2) vessel density in eyes with longstanding disease compared to eyes imaged at acute presentation (59.3, p=0.01)

Conclusions : CC ischemia correlates with hypofluorescent areas on ICG angiography and is larger than hyperfluorescent areas on FAF. There was a 62.4% reduction in size of CC ischemia with oral steroids suggesting its utility as a non-invasive surrogate in monitoring treatment response. Over time, there may be a superficial migration of the larger choroidal vessels in such eyes.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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