Electrophysiology in the diagnosis of Inflammatory Choroidopathies

Abstract

Purpose : The ocular conditions classified under the spectrum of Inflammatory Choroidopathies or “White Dot Syndromes (WDS)” can pose a diagnostic dilemma. We investigate how electrophysiology assists in diagnosing the WDS when combined with other forms of multimodal imaging.

Methods : Multi-centre retrospective study identifying patients that were diagnosed and subsequently treated for WDS. This database was obtained by analysing the available medical records of patients reviewed by the Uveitis team at Sydney Eye Hospital, Sydney, Australia and the Electrophysiology research team at Save Sight Institute, Sydney, Australia from the period between June 2005 to August 2019.

Results : 115 patients with WDS were identified. All patients had either formal fundoscopic examination or fundus imaging obtained from Optos ultra-wide field ™. Patients who were documented to have undergone multimodal imaging included OCT (82%), Autofluorescence (33%), fluorescein or indocyanine green angiography (32%). The most commonly diagnosed conditions included multifocal choroiditis (MFC) 36 patients (31%), acute zonal occult outer retinopathy (AZOOR) 34 patients (30%), Birdshot chorioretinopathy (BCR) 17 patients (15%) and Punctate Inner Choroidopathy (PIC) 14 patients (12%). These groups accounted for 94% of 65 WDS patients that underwent electrophysiology and helped confirm the final diagnosis of AZOOR (97%), BCR (88%), MFC (27%) and PIC (21%) (P= 0.000073, p< 0.05). 38 patients (33%) received systemic prednisolone treatment, 32 patients (28%) received local steroid/anti-VEGF injections and 20 patients (17%) received immunosuppression. At diagnosis, 107 patients had a mean visual acuity of 20/60 for the affected or worse eye(s), 4 patients had count fingers (CF), 3 had hand movements (HM) and 1 had light perception (LP). 55 patients had visual acuity documented at 2-years post-diagnosis; whereby 46 patients had a mean visual acuity of 20/40 for the affected or worse eye(s), 2 CF, 3 HM, 3 LP and 1 no-LP.

Conclusions : Our findings highlight that clinical assessment and the use of multimodal imaging alone may be sufficient for detecting the more commonly observed WDS conditions such as MFC and PIC, without the need for further electrophysiological studies to confirm diagnosis. Electrophysiology is useful for diagnosing other conditions within the WDS spectrum, including AZOOR and BCR, guiding treatment and visual prognosis.

This is a 2020 ARVO Annual Meeting abstract.