June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Optical Coherence Tomography Evaluation of Uveitic Macular Edema and Response to Treatment with Oral Carbonic Anhydrase Inhibitor Monotherapy
Author Affiliations & Notes
  • Macklin Hong Nguyen
    Ophthalmology, University of Washington, Seattle, Washington, United States
  • Cecilia Lee
    Ophthalmology, University of Washington, Seattle, Washington, United States
  • Russell N Van Gelder
    Ophthalmology, University of Washington, Seattle, Washington, United States
  • Kathryn L Pepple
    Ophthalmology, University of Washington, Seattle, Washington, United States
  • Footnotes
    Commercial Relationships   Macklin Nguyen, None; Cecilia Lee, None; Russell Van Gelder, None; Kathryn Pepple, None
  • Footnotes
    Support  NIH/NEI K23EY024921
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1233. doi:
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      Macklin Hong Nguyen, Cecilia Lee, Russell N Van Gelder, Kathryn L Pepple; Optical Coherence Tomography Evaluation of Uveitic Macular Edema and Response to Treatment with Oral Carbonic Anhydrase Inhibitor Monotherapy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1233.

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

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Abstract

Purpose : Oral carbonic anhydrase inhibitors (CAI) such as acetazolamide are offered to patients with refractory uveitic macular edema despite fluorescein angiography (FA) studies demonstrating limited efficacy. While optical coherence tomography (OCT) cannot visualize leakage, it can detect and monitor macular edema (ME). In addition, OCT can identify structural changes in the retina that FA cannot. We hypothesized that OCT would detect a benefit of CAI therapy on ME, and that there are OCT characteristics that would predict a response to CAI therapy.

Methods : A retrospective chart review identified patients treated with a CAI for uveitic ME between 2007 and 2014. Inclusion criteria included age ≥18, OCT with central subfield thickness (CST > 320), and follow-up OCT within 1 to 3 months. Exclusion criteria included new or increased systemic steroids, immune modulators, or Durezol within one month preceding CAI initiation or during the study. Baseline OCTs were scored for the presence of epiretinal membrane (ERM), subretinal fluid (SRF), cystic intraretinal fluid (cIRF), and vitreomacular traction (VMT). Fisher’s exact test and multivariate logistic regression were used to test for predictors of response and Wilcoxon signed-rank or student’s t-test were used to evaluate the macular thickness and visual acuity changes attributable to CAI therapy.

Results : 61 charts were screened. Sixteen subjects (19 eyes) met all criteria and were included. Subjects included nine females (56%), with a mean age of 57.9 years (19.7-81.1). The most common diagnosis was idiopathic uveitis (n=6, 31.6%) and mean duration of uveitis diagnosis was 4.4 years (0.2-27.5). Average CST decreased significantly with treatment from 471.8 ± 110.6 to 358.3 ± 50.4 (p<0.0001). Average visual acuity (LogMAR) improved significantly from 0.43 ± 0.25 to 0.27 ± 0.16 (p=0.003). Pretreatment OCTs revealed the presence of cIRF (n=19, 100%), SRF (n=8, 42.1%), ERM (n=13, 68.3%), and VMT (n=1, 5.2%). No specific characteristic was predictive of a response to therapy.

Conclusions : There is a significant benefit on CST and vision from CAI treatment in patients with uveitic ME. The small final number of patients analyzed may have limited our ability to identify predictors of response to therapy. However, these results suggest that in patients with refractory uveitis ME, treatment with a CAI may be warranted.

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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