Abstract
Purpose :
Patients with active uveitis with retinal vascular leakage (RL) on ultra-widefield fluorescein angiography (UWFA) may have normal foveal contour on spectral domain optical coherence tomography (OCT). In this study, we evaluate changes in fluorescein leakage on UWFA and changes in retinal thickness measures on OCT to determine the layers of retinal fluid accumulation on OCT in patients with uveitis.
Methods :
This is a retrospective IRB approved study. Patients were imaged with UWFA and OCT on the same day at baseline and follow-up visit. Patients included all had active uveitis with significant RL on UWFA and normal foveal contour with absence of macular edema on OCT scans at baseline and significant improvement of RL on UWFA post-treatment. OCT analysis software with manual expert reader-correction was used to segment the ILM, ONL, EZ, RPE, and Bruch’s membrane. Segmentation metrics for retinal volume (RV) and mean central subfield thickness (CST) on OCT were obtained. UWFA metrics of leakage area using 3, 6, 9-disc diameter areas centered on the macula were quantified using a fully automated customized software.
Results :
A total of 27 eyes from 21 patients (14 females, 7 males) were included in the study. At baseline, the average total RL on UWFA was 8.5%. After treatment, the average total RL decreased to 5.1%. The most significant improvement in RL on UWFA was seen within 3-disc diameters centered on the macula with an average change of 96% pre- and post-treatment. At baseline on OCT, the average total, outer (EZ-RPE), middle (ONL-EZ), and inner (ILM-ONL) RV was 11, 1, 3, and 7 mm3. On follow-up after treatment, the average total, outer, middle, and inner RV was 10, 1, 3, and 6 mm3.The average total, outer, middle, and inner CST at baseline was 290, 38, 126, and 127 µm. After treatment, the average total, outer, middle, and inner CST was 267, 37, 110, 120 µm. The most significant decrease in average CST occurred within the middle retinal layer.
Conclusions :
In uveitis patients with active RL and normal retinal contour, reduction in leakage leads to decrease in retinal thickness on OCT. The majority of improvement occurs in the middle retinal layer (ONL-EZ). Despite “normal” retinal contour, eyes with active RL have retinal edema. Normal retinal contour and thickness on OCT does not rule out active RL.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.