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Sho Ishikawa, Manzo Taguchi, Tadashi Muraoka, Masaru Takeuchi; Association between choroidal thickness and activity of ocular inflammation in Behçet's disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2942.
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Patients with ocular Behçet's disease (BD) develop uveitis characterized by iridocyclitis with hypopyon and retinal vasculitis initially manifested as either periphlebitis or vascular occlusion. BD uveitis has high recurrence rate with sudden onset and remission, and ocular findings are observed in the acute phase but not during remission. However, as diffuse dye leakage from retinal vessels is depicted by fluorescein angiography (FA) even in the remission phase. We investigated the choroidal thickness of BD patients in several stages of uveitis by spectral domain optical coherence tomography (SD-OCT), and examined whether choroidal thickness is an indicator of BD uveitis activity.
We recruited 9 patients (15 eyes) who fulfilled the diagnostic criteria of the International Study Group for Behçet’s Disease, and attended the uveitis clinic at National Defense Medical College between January and October 2012. The patients ranged in age from 28 to 45 years (average 36.7 +/- 7.3 years). Therapies were infliximab in 11 eyes, oral and topical steroids in 2 eyes, and topical steroid and oral colchicine in 2 eyes. Choroidal thickness was measured in various phases of uveitis by SD-OCT at enhance depth image (EDI) mode (Heidelberg®). The best correlated visual acuity (BCVA) and ocular inflammation scores were evaluated at every ocular examination and FA and indocyanine green angiography (IA) were performed as needed. JMP software version 5 was used for statistical analysis.
Inflammation score was 2.43 +/- 1.59 in the active phase and 0.93 +/- 1.03 in the remission phase. BCVA converted to logMAR was 0.19 +/- 0.50 in the active phase and 0.10 +/- 0.42 in remission. The mean EDI-OCT-based choroidal thickness at the fovea was 359 +/- 84.8 µm in the active phase and 293 +/- 74.8 µm in remission. A significant difference between the active and remission phase was observed only in choroidal thickness. Severe dye leakage in FA and hyperfluorescence of choroidal vessels in IA were observed in all BD patients with choroidal thickness greater than 400 µm. The number of ocular attacks correlated significantly with the reduced ratio of choroidal thickness (Spearman correlation coefficient: -0.60, p<0.01).
This study suggests that ocular inflammation in BD affects the choroid, and OCT-based choroidal thickness may be a useful parameter for evaluating the activity of uveitis in BD.
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