Vessel density on optical coherence tomography angiography is prognostic for future disease course in intermediate uveitis

Abstract

Purpose : To investigate longitudinal changes of retinal and choriocapillaris perfusion on optical coherence tomography angiography (OCT-A) in intermediate uveitis and the prognostic value for future best corrected visual acuity (BCVA) and central retinal thickness (CRT).

Methods : Eyes of patients with intermediate uveitis were imaged by swept-source OCT-A (macula 3x3mm; PLEX Elite 9000, Zeiss) and stratified into clinically stable, worsened and improved during follow-up based on changes in clinical parameters. Superficial (SRL) and deep retinal layers (DRL) were automatically analysed for vessel density (VD) and choriocapillaris layer for non-perfused area (CCNPA) using ImageJ. Mixed-effects regression analysis controlling for age, sex, and OCT-A signal strength index (SSI) was used to evaluate the prognostic value of OCT-A parameters.

Results : Ninety-one eyes (62 stable, 12 worsened, and 17 improved) were included in the analysis and mean review period was 296 days. Longitudinal changes of VD were different between all three groups (p=0.002 for SRL and p=0.017 for DRL). Clinically worsened eyes showed a decrease in VD (-0.032±0.055 for SRL and -0.027±0.025 for DRL), whereas clinically improved eyes showed an increase in VD (0.037±0.039 for SRL and 0.001±0.023 for DRL). No difference was found for CCNPA between all groups. When controlling for age, sex, and SSI, observed differences held true in clinically worsened eyes for DRL (p=0.011) and in clinically improved eyes for SRL (p=0.002). An increase of CCNPA in clinically worsened eyes (p=0.03) compared to clinically stable and improved eyes was evident. Predictive analysis revealed an association of VD in SRL and DRL at baseline with BCVA (p=0.039 and p=0.047, respectively) at follow-up and of VD in SRL at baseline with CRT (p=0.046) at follow-up.

Conclusions : Alterations in retinal perfusion on OCT-A in intermediate uveitis are partly reversible and OCT-A VD may serve to predict future BCVA and CRT. Thus, OCT-A might aid in monitoring and serve as prognostic biomarker.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.