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J Emanuel Carvalho, Dilraj Singh Grewal, Dhanes Thomas; Assessment Of Subclinical Microvascular Flow Characteristics In Aneurysmal Retinal Vasculitis Using Optical Coherence Tomography Angiography. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1686.
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© ARVO (1962-2015); The Authors (2016-present)
Microvascular flow abnormalities in retinal vasculitis may not be detected on fluorescein angiography due to obscured visualization from leakage. Using optical coherence tomography (OCT) angiography, we evaluated the presence of microvascular flow abnormalities in eyes with aneurysmal retinal vasculitis.
We reviewed 4 eyes of 3 patients with perinuclear antineutrophil cytoplasmic autoantibody (p-ANCA) associated retinal vasculitis, biopsy-proven eosinophilic granulomatosis with polyangiitis (EGPA) associated with retinal vasculitis, and idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN, N = 2 eyes). Fluorescein angiogram-directed OCT angiography imaging (Zeiss Angioplex, Carl Zeiss Meditec) of the areas of aneurysms (N =10) using 3 x 3 and 6 x 6 mm scan sections was performed.
In both p-ANCA and EGPA vasculitis eyes, superficial and deep capillary level perfusion abnormalities were seen in regions adjacent to all 6 aneurysmal dilations imaged. In none of these 6 areas, were capillary perfusion abnormalities detected using fluorescein angiography. Four of the 6 areas were also associated with surrounding intraretinal cystic fluid on OCT. Sub- internal limiting membrane aneurysmal outpouchings were confirmed on OCT in all 6 areas. The inner choroid in these areas showed loss of detail and a diffuse increase in reflectivity.In both eyes of the patient with IRVAN, scanned 3 years after being treated with a course of oral steroids, no microvascular abnormalities were detected in all 4 aneurysmal areas imaged.
Widespread subclinical capillary perfusion abnormalities develop in both the superficial plexus and deep vascular plexus in regions adjacent to inflammatory aneurysmal dilations, which are not detected using fluorescein angiography. The spectrum of these perfusion abnormalities suggests that early treatment of milder disease may potentially prevent the development of these microvascular abnormalities. It is also possible that immunoglobulin (Ig) E and mast cell-mediated damage in EGPA and IgG mediated cytotoxic hypersensitivity and vascular endothelial cell damage in p-ANCA vasculitis has a greater severity of perivascular inflammatory damage than IRVAN. OCT angiography allows recognition of these subclinical microvascular abnormalities and thus may serve as a non-invasive tool to monitor progression.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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