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C. Castellano, S. Stinnett, P. S. Mettu, R. M. McCallum, G. J. Jaffe; Retinal Thickening in Iridocyclitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):801.
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Severe iridocyclitis (IC) is associated with cystoid macular edema. However, an association between less severe anterior chamber (AC) inflammation and macular thickening in eyes without clinically evident posterior segment inflammation has not been well described. Herein we determined the incidence of retinal thickening in eyes with IC and examined the correlation between anterior chamber inflammation, retinal thickening, and visual acuity.
Records were reviewed on patients seen at the Duke Eye Center Uveitis Clinic from 1/02 -7/07. Patients with unilateral IC who had OCT performed on both eyes were included. Patients with panuveitis, vitritis, pars planitis, and/or posterior uveitis were excluded. Other exclusion criteria included: history of ocular surgery, preexisting macular disease and preexisting ocular or systemic disease that could cause macular edema. AC cell grade was recorded. The Stratus OCT fast macular thickness map protocol was used to measure retinal thickness; subretinal fluid (SRF) and intraretinal cysts were determined from line scans according to Duke OCT Reading Center guidelines.
For 32 patients, the mean age was 44.3 (+/-18.6) years. Three patients had acute (1st episode), 9 had acute recurrent, and 18 had chronic IC. The diagnoses (n) were as follows: HLA-B27-associated (14), herpetic (4), JRA (2), idiopathic (12). AC cell grade ranged from 0 to 4+. Four patients had CME and 1 had SRF. The median study eye-fellow-eye difference was statistically significant for the 3mm subfield, 6mm subfield and the combined 3mm and 6mm subfields of the OCT macular thickness map and for total macular volume (p<0.001). In the study eye, the degree of retinal thickness correlated with the number of cells in the anterior chamber for the 6mm subfield of the OCT map (p=0.052). In the 3mm subfield, retinal thickness measurements above the 75th percentile correlated with visual acuity (p=0.046).
Retinal thickening determined by OCT is a sensitive indicator of anterior chamber inflammation, even in eyes with low grade AC cells. Outside the foveal center, the degree of retinal thickening correlated with the degree of anterior segment inflammation over a broad range of inflammation severity. Visual acuity correlates with the degree of thickening once thickening has progressed beyond a certain point. We anticipate that this information will help guide the clinician to make treatment decisions based on the presence of retinal thickening.
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