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Michel Paques, Marie-Hélène Errera; Imaging of paravascular infiltrates and epiretinal proliferation in posterior uveitis using adaptive optics. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2940.
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Posterior uveitis may present with a variety of fundus features. Retinal vasculitis is characterized by the presence of paravascular inflammatory infiltrates, which are often difficult to document with precision with currently available imaging systems. Epiretinal proliferation is also a commojn complication of posterior uveitis. Here, we report the findings of adaptive optics (AO) near infrared imaging in patients with posterior uveitis of various etiologies.
Ten patients with posterior uveitis seen in our department were included. The diagnoses associated with uveitis were 2 cases of Lyme's disease, two cases of multiple sclerosis, one case of idiopathic retinal vasculitis, aneurysm and neuroretinitis (IRVAN), and five idiopathic cases. All underwent routine ophthalmological and general workup in addition to AO NIR flood imaging (rtx1, ImagineEye, Orsay, France) within a IRB-approved protocol.
AO imaging showed foci of grayish linear infiltrates (0.5-3 mm in length, up to 50 µm in width) alongside veins (see figure) in 7 patients. They were more often detected in areas where there was irregularity of the vessel lumen. The case of IRVAN had infiltrates around veins as well as around arteries, especially around macroaneurysms. These infiltrates were not or very faintly visible by funduscopy, fluorescein angiography or optical coherence tomography. Follow-up demonstrated that there was slow, continuous remodelling of both the infiltrate and of the underlying venous stenosis. In the three other cases, small foci of epiretinal membranes were disseminated along vessels.
AO imaging is of interest to identify the presence of paravascular inflammatory infiltrates and of early stages of epiretinal membranes. These features appear more prevalent than previously thought since they can be observed in funduscopically and angiographically normal fundi. We found that irregularity of the venous lumen is a strong indicator of the presence of inflammatory infiltrates. Detection of paravascular infiltrates may be of interest for establishing a diagnosis of vasculitis in patients with inflammatory syndromes, either ocular or general. The significance of epiretinal membrane formation during uveitis remains to be determined. Monitoring of these features may also be useful for therapeutic management.
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