Abstract
Purpose :
To assess the utility of oral ultra-widefield oral fluorescein angiography (O-UWFFA) to identify retinal vascular leakage in non-infectious uveitis compared with intravenous fluorescein ultra-widefield fluorescein angiography (IV-UWFFA).
Methods :
Cross sectional study of angiographic images from patients with intermediate, posterior or panuveitis who had IV-UWFFA and O-UWFFA between March 1, 2016 and March 1, 2019 at the Proctor Foundation at the University of California, San Francisco. Patients with media opacities precluding view of the posterior segment, prior globe trauma or non-uveitic macular or retinal disorders and those with poor image quality were excluded. All images were graded by two masked ophthalmologists and one uveitis expert. We defined the pattern of leakage on angiography at the late phase as 1) diffuse retinal vascular leakage, 2) peripheral leakage, 3) macular leakage, and 4) disc leakage; graders identified the absence or presence of these angiographic patterns. The reliability of the agreement of angiogram analysis was assessed using kappa statistics.
Results :
16 patients provided 32 O-UWFFA and 32 IV-UWFFA images. For intra-observer agreements of O-UWFFA and IV-UWFA in detecting diffuse leakage, the first ophthalmologist exhibited a fair kappa (0.33, p<0.05), the second ophthalmologist had a moderate kappa (0.6, p<0.01) and the expert had a moderate kappa (0.5, p< 0.05). Respective kappas for intra-observer agreement of O-UWFFA and IV-UWFFA in detecting peripheral leakage was moderate for the first ophthalmologist (kappa=0.60, p<0.01), moderate for the second ophthalmologist (kappa=0.51, p<0.01) and perfect for the expert (kappa=1, p<0.05). The inter-observer agreement between 2 graders in detecting diffuse or peripheral leakage on O-UWFFA were both moderate (kappas of 0.46, p<0.01 and 0.43, p<0.05, respectively). The inter-observer agreement between 2 graders in detecting diffuse leakage on IV-UWFFA was substantial (kappa=0.67, p<0.01) and was fair in detecting peripheral leakage on IV-UWFFA (kappa=0.28, p=0.10).
Conclusions :
O-UWFFA, a less invasive test than IV-UWFFA, may be sufficient in detecting retinal vascular leakage in patients with uveitis.
This is a 2020 ARVO Annual Meeting abstract.