Elsevier

Ophthalmology Retina

Volume 5, Issue 12, December 2021, Pages 1226-1234
Ophthalmology Retina

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

Presented at: the Association for Research in Vision and Ophthalmology Annual Meeting, May 3–7, 2020, Baltimore, Maryland.
https://doi.org/10.1016/j.oret.2021.02.007Get rights and content

Purpose

To introduce a novel method for assessment of retinal vasculitis using swept-source OCT angiography (SS-OCTA).

Design

Retrospective case series.

Participants

Patients with retinal vasculitis.

Methods

The subjects were identified among the clinic population and imaged with 12 × 12-mm SS-OCTA scans centered on the fovea. A custom retina segmentation superimposed the color retinal thickness map on a modified en face flow scan. Findings from en face flow scans were correlated with localized perivascular retinal thickening on B-scans. Results from SS-OCTA were compared with fluorescein angiography (FA) to examine the proportion of perivascular thickening to retinal vascular leakage or staining.

Results

Twenty-one patients with retinal vasculitis underwent same-day FA and SS-OCTA. Visible retinal vascular leakage/staining on FA corresponded to increased perivascular retinal thickness on SS-OCTA in 17 patients. Five patients had a second examination with same-day FA and SS-OCTA after treatment of the vasculitis. Three of those 5 patients showed improved retinal vascular leakage/staining on post-treatment FA and decreased perivascular retinal thickness on SS-OCTA scans.

Conclusions

Swept-source OCT angiography detects structural retinal thickening secondary to inflammatory retinal vascular leakage. Further studies are required to confirm whether SS-OCTA may serve as a semiquantitative alternative to FA to diagnose and monitor the response to treatment in patients with retinal vasculitis.

Section snippets

Methods

This retrospective case series was performed in accordance with the Declaration of Helsinki and the Health Insurance Portability and Accountability Act of 1996, and was approved by the Institutional Review Board of the University of Miami Miller School of Medicine. No study-specific informed consent or authorization was required because it was a retrospective review of images obtained during routine clinical care. However, all patients had signed a consent to undergo SS-OCTA based on the

Results

From August 2016 to November 2019, 21 patients with a prior diagnosis of retinal vasculitis underwent SS-OCTA imaging at Bascom Palmer Eye Institute and same-day FA. Seventeen patients had retinal vascular leakage or staining in the posterior pole on FA and were considered to have active retinal vasculitis. Of these 17 patients, there were 8 with BSCR, 2 with pars planitis, 1 with intraocular lymphoma, and 1 with syphilis. The 5 remaining patients were diagnosed with an undifferentiated

Discussion

OCTA is a desirable imaging modality because it is quick and noninvasive. The high-resolution en face OCTA of retinal blood flow co-registers with a retinal thickness map and multiple corresponding structural OCT B-scans.13 Many studies have reported the utility of OCTA in age-related macular degeneration and diabetic retinopathy.15,16,23 To date, there has been a limited clinical role for OCTA in uveitis because of its inability to directly show real-time retinal vascular leakage and

Conclusions

Our descriptive study presents a method to demonstrate retinal vasculitis on OCTA. However, for more unbiased evaluation, a quantitative study is required to grade the retinal vasculitis on FA and compare it with the perivascular retinal thickness on OCTA in a blinded fashion. This provides more quantitative data such as sensitivity and specificity of OCTA compared with FA for detection and monitoring of retinal vasculitis.

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  • Cited by (0)

    Research supported by grants from the National Eye Institute (R01EY024158, R01EY028753), Carl Zeiss Meditec, Inc., the Salah Foundation, an unrestricted grant from the Research to Prevent Blindness, Inc., and the National Eye Institute Center Core Grant (P30EY014801) to the Department of Ophthalmology, University of Miami Miller School of Medicine. The funding organizations had no role in the design or conduct of this research.

    Disclosure(s): All authors have completed and submitted the ICMJE disclosures form.

    The author(s) have made the following disclosure(s): J.L.D.: Rresearch grant funding -- Biogen, EyePharma, Johns Hopkins University; Consultant – Kodiak, 4D Molecular Therapeutics. G.G.: Research support -- Carl Zeiss Meditec, Inc. G.G. and the University of Miami co-own a patent that is licensed to Carl Zeiss Meditec, Inc. P.J.R.: Research support -- Carl Zeiss Meditec, Inc, Stealth BioTherapeutics; Consultant -- Apellis, Biogen, Boehringer-Ingelheim, Carl Zeiss Meditec, Chengdu Kanghong Biotech, EyePoint, Ocunexus Therapeutics, Ocudyne, Unity Biotechnology; Equity interest -- Apellis, Valitor, Verana Health, Ocudyne. T.A.B.: Research funding from Klorfine Foundation; consulatant -- Adverum Biotechnologies, Allergan, B+L/Valeant Pharmaceuticals, Beaver Visitec, Clearside Biomedical, Inc., Eyepoint Pharmaceuticals, Genentech, Novartis, RegenexBio; member of the Data Safety Monitoring Committee at Applied Genetic Technologies Corp., and Novartis.

    HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at the University of Miami Miller School of Medicine approved the study. All research adhered to the tenets of the Declaration of Helsinki. No study-specific informed consent or authorization was required because it was a retrospective review of images obtained during routine clinical care. However, all patients had signed a consent to undergo SS-OCTA based on the institute protocol for SS-OCTA imaging.

    No animal subjects were included in this study.

    Author Contributions:

    Conception and design: Noori, Shi, Yang, Gregori, Albini, Rosenfeld, Davis

    Data collection: Noori, Shi, Yang, Gregori, Albini, Rosenfeld, Davis

    Analysis and interpretation: Noori, Shi, Yang, Gregori, Albini, Rosenfeld, Davis

    Obtained funding: N/A

    Overall responsibility: Noori, Shi, Yang, Gregori, Albini, Rosenfeld, Davis

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