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Paolo Milella, Gaia Leone, Chiara Mapelli, Marco Nassisi, Giada Ruggi, Antonio Scialdone, Francesco Viola; Adaptive optics imaging characteristics of Varicella Zoster Virus retinal segmental periarteritis. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4433 – F0112.
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© ARVO (1962-2015); The Authors (2016-present)
Retinal segmental periarteritis (Kyrieleis plaques) is a rare condition in which white-yellowish exudates are placed in beaded pattern within the retinal arteries. The aim of the study is to report the adaptive optics (AO) imaging characteristics of arterial vasculitis in Varicella Zoster Virus (VZV) related posterior uveitis and correlate it with other imaging modalities.
Patients diagnosed with VZV posterior uveitis and evidence of retinal segmental periarteritis underwent multimodal imaging including fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) and AO.
3 patients (1 female; median age 78 years) were recruited. In all cases, AO images showed arterial wall involvement, perivascular opacification, and focal lumen irregularities. However, the arterial walls were never disrupted. There was no vein involvement. In one case, glistening whitish spots were evident on the surface of the arterial wall, which corresponded to an intense hyperreflectivity on OCT and late focal hypofluorescence on FA and ICGA. In general, arterial plaques showed late iso/hypofluorescence on FA and ICGA. In all cases, arterial plaques modifications were far more evident on AO than angiographic exams.
AO imaging confirms that nodular periarteritis involves arterial walls, but it remains confined within them. Furthermore, AO seems more sensitive to detect vascular inflammation at microscopic level than traditional imaging. Additional studies will be needed to further explore the diagnostic and prognostic value of these findings.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
(A) Segmental retinal periarteritis appears as whitish nodular deposits within the wall of retinal arteries. Late fluorescein (B) and indocyanine green (C) angiography shows no leakage of the lesions. (D) Adaptive optics imaging shows segmental perivascular opacification around the wall of the retinal artery (yellow arrowheads), which corresponds to focal hyperreflectivity of the vessel on OCT (E).
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