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Lucia Sobrin, Laura Nicholson, Parvathy Pillai, Heeyoon Cho; Reactive and infiltrative papillitis in uveitis: response to treatment and use of optic nerve optical coherence tomography for monitoring. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5809.
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To describe the clinical characteristics and response to treatment in patients with reactive or infiltrative papillitis associated with uveitis and to evaluate spectral domain optical coherence tomography (SD-OCT) as a tool for monitoring the response to anti-inflammatory treatment in these patients.
This IRB-approved, retrospective study included patients with reactive or infiltrative papillitis secondary to uveitis who had optic nerve SD-OCT imaging on the Uveitis Service at the Massachusetts Eye and Ear Infirmary between January 2010 and July 2013. Clinical data, including uveitic inflammatory grade as measured using the Standardization of Uveitis Nomenclature criteria, were obtained from the medical record. Optic nerve imaging was performed with the Heidelberg Spectralis SD-OCT. The imaging protocol included three different measurements: an optic nerve head (ONH) thickness map, a one-point measurement of ONH thickness and a peripapillary retinal nerve fiber layer (RNFL) thickness map. We used a paired t-test to compare mean ONH and peripapillary RNFL thickness measurements at the time of active inflammation with those obtained when uveitis was inactive. For the statistical tests, only one, randomly selected eye of patients who had bilateral disease was analyzed.
Twenty-three eyes of 14 patients were included. Ten patients had reactive papillitis; two were secondary to anterior uveitis and eight were associated with posterior uveitis. The remaining four patients had infiltrative papillitis. Among patients with reactive papillitis, resolution of ONH elevation often lagged behind resolution of uveitis. There was a statistically significant difference in optic nerve thickness by ONH thickness map measurement in active vs. inactive uveitis (569 µm vs. 407 µm, p= .008). Although the one-point ONH and peripapillary RNFL measurements were higher in active uveitis vs. inactive uveitis (625 µm vs. 526 µm and 139 µm vs. 115 µm, respectively), these differences were not statistically significant.
Optic nerve elevation in papillitis secondary to uveitis as quantified by the SD-OCT ONH thickness map correlates with presence vs. resolution of uveitis. Further study is required to determine if the SD-OCT ONH thickness map protocol can be used to non-invasively monitor treatment response in patients with papillitis due to uveitis.
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