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P. Y. Chang, V. Diaz, D. M. Hinkle, J. Mauro, C. S. Foster, C. M. Samson; Spectral-Domain Optical Coherence Tomography in Resolved Uveitic Cystoid Macular Edema: Features Associated With Permanent Vision Loss. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1047.
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Cystoid macular edema (CME) is a common complication of uveitis, resulting in significant vision loss. Vision typically recovers with the resolution of CME. However, a subset of patients experience permanent decrease of central vision despite resolution of CME and absence of pathology in other ocular structures. Using spectral-domain optical coherence tomography (OCT) imaging technology, we attempted to identify retinal features that may be associated with the vision loss.
This is a case-control retrospective comparative series. We reviewed medical records of patients with uveitic CME and identified two groups of patients: 1) Study group consisted of patients who failed to regain pre-CME BCVA following resolution of CME, and the vision loss could not be accounted for by other ocular pathologies; 2) Control group consisted of patients who regained their pre-CME BCVA following resolution of CME. Once all patients were identified, we reviewed the OCT scans obtained from the RTVue (Optovue Inc, Fremont, CA) of each patient. Patients were excluded if macular cystic space, epiretinal membrane, or distorted macular anatomy was noted. Two variables were then assessed in the qualified subjects: 1) Photoreceptor inner/outer segment (IS/OS) junction, hypothesized to be represented by the highly reflective band immediately inner to the retinal pigment epithelium, is graded as intact, partially intact, or absent by two observers who are masked to the patient grouping. 2) Foveal thickness, as calculated by the software program included with the RTVue. Pre- and post-CME BCVA were also recorded.
There were 7 subjects (8 eyes) in Study and 8 subjects (8 eyes) in Control. The mean pre-CME BCVA were 20/25 in Study and 20/20 in Control. The mean post-CME BCVA were 20/75 in Study and 20/20 in Control. The mean foveal thickness were 170.3µm in Study and 232.6µm in Control, with a difference of 62.4µm (p<0.001). IS/OS junction was graded as intact in 2, partially intact in 4, and absent in 2 of the Study eyes, while it was graded as intact in all 8 Control eyes. All Study eyes had a foveal thickness of less than 180µm, a non-intact IS/OS junction, or a combination of both.
This preliminary study suggests that reduced foveal thickness and disrupted photoreceptor IS/OS junction as seen on spectral-domain OCT may be associated with permanent vision loss following CME resolution in uveitic patients.
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