A Novel Method to Detect and Monitor Retinal Vasculitis Using Swept Source OCT Angiography

Abstract

Purpose : To introduce a novel method for visual assessment of retinal vasculitis using Swept Source OCT Angiography (SS-OCTA).

Methods : Patients with retinal vasculitis who underwent same-day fluorescein angiogram (FA) and SS-OCTA were identified among the clinic population. OCT images were acquired using PLEX^Ò Elite 9000 (Carl Zeiss Meditec, Inc, Dublin, CA) and consisted of 12 x 12 mm OCTA scans centered on the fovea. The pseudo-color retinal thickness map produced by the instrument’s software was superimposed on a modified en-face flow scan. The enface OCT maps were reviewed and correlated qualitatively with the retinall vasculitis and the capillary non-perfusion or hypoperfusion areas on FA.

Results : Twenty-one patients with retinal vasculitis underwent same-day FA and SS-OCTA. Visible retinal vascular leakage on FA corresponded to increased perivascular retinal thickness on SS-OCTA in 17 patients. Five patients had a second examination after treatment of the vasculitis. Three of 5 patients had improved retinal vascular leakage on post-treatment FA as well as decreased perivascular retinal thickness on SS-OCTA scans. Four eyes of 2 patients showed capillary non-perfusion on both FA and SS-OCTA. Retinal ischemia presented as loss of flow on enface scans of the superficial and deep retinal plexus slabs.The regions with decrease of retinal thickness on pseudo-color retinal thickness map and B-scan correlated with hypo-perfused areas on FA.

Conclusions : SS-OCTA is an effective tool to visualize the structural retinal thickening secondary to inflammatory retinal vascular leakage and can detect retinal hypo-perfusion secondary to vasculitis. SS-OCTA may serve as semi-quantitative alternative to FA to diagnose and monitor the response to treatment in patients with retinal vasculitis.

This is a 2020 ARVO Annual Meeting abstract.

 

Top row: FA of right eye (5-minute) (A1), custom en-face with color thickness map (CRT scan) (B1), custom structure en-face (C1),and B-scan (D1) in a patient with BSR. Middle row: FA (A2), CRT(B2), custom structure en-face (C2), and B-scan (D2) following treatment. Bottom row: ischemic vasculitis: late phase of FA (E) with focal hypo-perfused areas on superficial (F) deep (G), CRT (H), custom structure (I) and B-scan (J).

 

Wide field FA (5-minute) (A1) shows leakage of large vessels in a patient with BSR. The retinal thickness on horizontal (H) and vertical (V) B-scans at point 405 X 250 shows reduction 5 months after treatment.