Imaging Outcomes Using Ultra-Widefield Fluorescein Angiography in Uveitis Patients on Adalimumab

Abstract

Purpose : In this study we investigated whether quantitative analysis of leakage on ultra-widefield fluorescein angiography (UWFA) correlated with disease activity and severity in uveitis patients treated with adalimumab.

Methods : This is a retrospective case series. Patients were included if they were diagnosed with uveitis, were taking adalimumab during the 12-month follow-up period, had follow-up visits, and had UWFA imaging taken. Patients were classified as responsive to adalimumab if they had improvement or stabilization of disease on exam and/or imaging at 12-month follow-up; patients were categorized as non-responders if they had worsening disease at 12 months, stopped treatment, or switched to a different medication. Automated software (Early and Late phase Selection Application) was used to select the highest quality late-frame UWFA image. Leakage as a percent of retinal area was quantified using an automated algorithm (Image-Pro Analyzer 7.0). Leakage area and percent change in leakage over time were compared to LogMAR visual acuity, clinical disease activity, and treatment success or failure using linear regression analysis and two-tailed Student’s t-test.

Results : A total of 20 patients (13 female, 7 male) were included in this study. 13 of 20 patients (65%) demonstrated some response to adalimumab, whereas 7 of 20 patients (35%) had no treatment response. At 12 months, treatment-responsive patients had a 62% decrease in leakage area compared to baseline, whereas treatment-failure patients had a 513% increase in leakage compared to baseline (p = 0.02). There was a small albeit significant correlation between leakage area and visual acuity (r² = 0.08, p < 0.001).

Conclusions : In this study, we show that leakage correlates with visual acuity and clinical response to adalimumab. Quantitative analysis of leakage on UWFA may be a useful novel biomarker in the evaluation of non-infectious uveitis in the clinical and research settings.

This is a 2021 ARVO Annual Meeting abstract.