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Alexandra Pierru, Marie-Hélène Errera, Jean-Francois GIRMENS, Jonathan Benesty, Christophe Baudouin; Diagnosis of choroidal neovascularization in uveitis by optical coherence tomography angiography. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1639.
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© ARVO (1962-2015); The Authors (2016-present)
To detect and quantify choroidal neovascularization (CNV) in uveitis patients using optical coherence tomography angiography (OCT-A).
Patients were seen at the uveitis clinics at the 15-20 hospital. Each patient underwent a complete ophthalmologic examination including best-corrected visual acuity (BVCA), slit-lamp biomicroscopy, SD-OCT, FA and Indocyanin green angiography (ICG). SD-OCT, FA and ICG were performed with the Spectralis® HRA+OCT (Heidelberg Engeneering, Germany). OCT-A scans were obtained by the AngioVue Imaging System (Optovue, Inc., Freemont, CA) to obtain split-spectrum amplitude decorrelation angiography (SSADA) images. Three dimensional (3D) OCT angiography scans were acquired over 3x3 mm and 6x6mm regions and were centered on the region of interest.
Six patients with four various etiologies of uveitis (one punctate inner choroidopathy (PIC), three multifocal choroiditis (MFC), one Vogt-Koyanagi-Harada (VKH), and one toxoplasmosis) were included. En face OCT angiograms of CNVs showed their morphology, extend, depth and locations that were confirmed by fluorescein angiography. OCT angiography provided more distinct vascular network patterns. Cross-sectional structural OCT image with an OCT angiogram overlay revealed that most of the CNV flow was above the retinal pigment epithelium (RPE) indicating a predominantly type 2 CNV, as well as the presence of fluid exudation and disruption of outer retinal anatomy. Type 2 lesions presented as a hyperflow lesion, well circumscribed in the outer retina, with a glomerulus or medusa shape surrounded by a dark halo.
OCT angiography is a new noninvasive imaging method for the diagnosis of CNV secondary to uveitis. In those inflammatory ocular diseases where sometimes it is difficult to differenciate between retinal and/or choroidal inflammation and mild CNV, OCT angiography may have a role. Further studies are needed to confirm that a prompter treatment can be initiated with OCT angiography compared with structural OCT and FA. The early detection of CNV is mandatory in order to keep the inflammation under control and is beneficial for the visual prognosis of those potentially blinding conditions.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Case 1 with MFC: type 2 CNV. A, En face angiogram of the outer retina showing the CNV. B, Cross-sectional OCT angiogram showing the CNV was predominantly above the RPE. C, Late-phase FA.
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