Characterization of serous retinal detachments in uveitis patients with optical coherence tomography

Multifocal Chorioretinitis with Serous Macular Detachment in Diffuse Unilateral Subacute Neuroretinitis (DUSN): Unique Presentation and a Diagnostic Dilemma

PURPOSE

To report a case of multifocal chorioretinitis with serous macular detachment in diffuse unilateral subacute neuroretinitis (DUSN) and its diagnostic dilemma.

DESIGN

Case report.

METHOD

A 43-year-old woman presented with painless diminution of vision of right eye for 1 week. Dilated fundoscopy showed mild disc edema, multiple deep grey-white retinitis lesions in posterior pole with mild vitritis. Optical coherence tomography revealed serous macular detachment. Fundus fluorescein angiography was suggestive of active retinitis. Comprehensive workup was unremarkable. Six days later, a live subretinal worm was noticed in inferotemporal retina. A diagnosis of DUSN was made and treated with laser photocoagulation followed by antihelminthic therapy. One month later, patients vision improved and chorioretinal lesions also healed.

CONCLUSION

This report presents a unique scenario of serous macular detachment in DUSN in addition to commonly seen multifocal deep retinitis lesions. Prompt treatment with laser, antihelminthic agent can prevent irreversible vision loss.

En face optical coherence tomography patterns in patients with angiographically documented uveitic macular edema: a cross-sectional retrospective study

PURPOSE

To elucidate the en face optical coherence tomography (OCT) patterns of macular edema in eyes with angiographically documented uveitic macular edema (UME) and compare visual acuity (VA), OCT and OCT-angiography (OCT-A) parameters among the morphological subgroups.

METHODS

Thirty-nine eyes of 29 patients with angiographically proven UME were enrolled into the study. All patients underwent comprehensive ophthalmological examination including structural OCT and OCT-A in addition to fluorescein angiography. Eyes with UME were divided into three subgroups (petaloid, sunflower and spoke-wheel pattern) with the help of en face OCT imaging.

RESULTS

Posterior uveitis was the most common type of uveitis (17 patients; 58.7%), followed by panuveitis (11 patients; 37.9%) and then intermediate uveitis (1 patient; 3.4%). Underlying causes of uveitis were Behçet's disease (13 patients; 44.8%), idiopathic (11 patients; 37.9%), rheumatoid arthritis (2 patients; 6.9%), sarcoidosis (1 patient; 3.4%), inflammatory polyarthritis (1 patient; 3.4%) and psoriatic arthritis (1 patient; 3.4%). The most common en face OCT pattern was petaloid type (25 of 39 eyes; 64.1%). Eleven eyes (28.2%) had sunflower pattern and three (7.7%) spoke-wheel pattern. There were no statistically significant difference among the subgroups regarding the age, VA, central macular thickness and vessel density.

CONCLUSION

This study reveals three morphological en face OCT patterns in eyes with UME and en face OCT may find a niche in the UME classification with the accumulation of experience among the uveitis experts.

The impact of central foveal thickness and integrity of the outer retinal layers in the visual outcome of uveitic macular edema

Background

To analyze the relationship between the central foveal thickness (CFT) and the integrity of the ellipsoid portion of inner segments (EPIS) and interdigitating zone (IZ) retinal layers in the visual outcome of uveitic macular edema (UME).

Methods

Prospective, observational, and cross-sectional study of eyes with UME. Spectral-domain optical coherence tomography (SD-OCT) macular morphological pattern, CFT, and integrity of the outer retinal layers were analyzed. We arranged the data by EPIS or IZ integrity and contrasted it with student t-test (quantitative variables) and Fisher exact test or χ² distribution (categorical variables) to evaluate visual impairment and retinal measures. Receiver operator curve (ROC) estimation and logistic regression (probit) assessed if the sample´s variance could be associated with IZ or EPIS integrity.

Results

We included 145 SD-OCT macular scans from 45 patients at different stages of UME. Cystoid macular edema (CME) increased the risk of severe (P ≤ 0.0162) and moderate visual loss (P ≤ 0.0032). The highest CFT values occurred in patients with moderate (478.11 ± 167.62 μm) and severe (449.4 ± 224.86 μm) visual loss. Of all morphological patterns of macular edema, only CME showed a statistically significant relationship with severe visual impairment (44.92%, p = 0.0035, OR 4.29 [1.62–11.4]). Likewise, an increased probability of severe visual loss correlated negatively with both, IZ (37.93%, P ≤ 0.001, OR 10.02) and EPIS (38.98%, P ≤ 0.001, OR 13.1) disruption. A CFT > 337 μm showed a higher probability of IZ (AUROC = 0.7341, SEN 77.59%, ESP 65.52) and EPIS (AUROC = 0.7489, SEN 76.37%, ESP 65.12%) loss of integrity. Moreover, when BCVA reached 0.44 LogMAR (≤ 20/50 Snellen eq.), it was more likely to have IZ (AUROC = 0.8706, ESP 88.51%, SEN 77.59%) and EPIS (AUROC = 0.8898, ESP 88.3%, SEN 76.27) disruption.

Conclusions

Significantly increased CFT has a higher probability for EPIS and IZ disruption, which significantly increases the risk for irreversible visual loss in eyes with UME. Evaluating these layers’ integrity by optical coherence tomography helps predict the visual outcome and make the right therapeutic decisions.

Trial registration The study was registered on April 13, 2020, at the Instituto Tecnologico y de Estudios Superiores de Monterrey Research Committee (License No. COFEPRIS 20 CI 19 039 002), project registration No. P000338-CAVICaREMU-CI-CR002, and the Ethics Committee (License No. CONBIOETICA 19 CEI 011-2016-10-17), project registration No. P000338-CAVICaREMU-CEIC-CR002

Spectral domain optical coherence tomography evaluation of macular changes in Eales disease

Purpose:

The purpose of the study was to describe macular changes in treatment-naïve eyes with Eales disease using spectral domain optical coherence tomography (SD-OCT).

Methods:

A cross-sectional study was done on 79 eyes of 66 patients with Eales disease. Best-corrected visual acuity (BCVA), slit-lamp biomicroscopy (SLB), indirect ophthalmoscopy, fundus fluorescein angiography (FFA), and quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT were performed.

Results:

Forty-six (58.2%) eyes had macular involvement as assessed with SD-OCT, while in 33 (41.8%) eyes, macula was not affected. Macular edema was the most common feature when macula was affected followed by epiretinal membrane. Mean CMT was higher (315.3 ± 102.3 μm) in eyes with macular involvement than those without it (243.8 ± 19.3 μm). Eyes with active vasculitis involving larger vessels and neovascularization had greater chance of macular involvement. SLB and FFA alone missed 28.3% and 50% eyes with macular abnormalities on SD-OCT, respectively.

Conclusion:

While the clinical description of Eales disease points mainly to a peripheral location, macular involvement can be commonly picked up when SD-OCT is used. Macular involvement when present is associated with a poorer BCVA.

Intravitreal bevacizumab for postviral fever retinitis: a novel approach for early resolution of macular oedema

Severe macular oedema causing marked loss of vision is seen in cases of retinitis developing postviral fever. The use of antivascular endothelial growth factor agents for macular oedema and submacular fluid secondary to viral retinitis has not been studied or well established in the past. We report a case series of two patients of postviral retinitis with severe macular oedema resistant to steroid therapy, treated with intravitreal bevacizumab. The patients showed significant symptomatic improvement in the visual acuity. The retinitis lesions resolved slowly and macular oedema regressed. Bevacizumab appears to be a safe and useful agent to manage macular oedema subsequent to postviral retinitis. An early resolution of macular oedema helps in the preservation of visual acuity which left untreated can cause severe visual loss.

Spectral-domain optical coherence tomography findings of the macula in 500 consecutive patients with uveitis

PurposeTo analyze the macular structure in a large series of consecutive patients with different types of uveitis using spectral-domain optical coherence tomography (SD-OCT).Patients and methodsFive hundred eyes of 500 consecutive patients with anterior, intermediate, posterior, and panuveitis underwent standardized macular examination using SD-OCT. Central retinal thickness (CRT), macular volume (MV), and presence of cystoid macular edema (CME), diffuse macular edema (DME), serous retinal detachment (SRD), epiretinal membrane with (ERM+) and without (ERM-) retinal surface wrinkling were determined.ResultsThe anatomic location of inflammation affected significantly CRT and MV (P<0.001, respectively), with the highest values in intermediate and panuveitis. CME was seen in 25% of all uveitic eyes, DME in 11%, SRD in 8%, ERM+ in 18%, and ERM- in 13%. CME was most frequent in intermediate (40%) and panuveitis (36%); DME was most frequent in panuveitis (18%) and posterior uveitis (17%); SRD was most frequent in panuveitis (15%) and posterior uveitis (10%); ERM+ was most frequent in panuveitis (45%) and intermediate uveitis (30%); and ERM- was most frequent in intermediate (14%) and posterior uveitis (15%).ConclusionSD-OCT of the macula is recommended for all uveitis patients. CRT, MV, and the incidence of CME were highest in intermediate and panuveitis.

Optical coherence tomography and histopathology of macular uveitis

PURPOSE

Spectral-domain optical coherence tomography (SD-OCT) is a noninvasive technique that can provide high-resolution images of macular morphology. The purpose of this study was to examine the pathological mechanism of uveitis and compare the changes in the macula of uveitis patients and the histopathological features of experimentally induced uveitis in mice.

METHODS

Macular OCT was performed on 78 eyes of 51 patients of the Eye Hospital of Shandong University of Traditional Chinese Medicine, China, with apparent uveitis changes. C57BL/6 mice were injected with interphotoreceptor retinoid-binding protein (IRBP)-specific T cells from naïve mice immunized with complete Freund adjuvant IRBP(1-20) to induce uveitis. The disease was monitored by indirect fundoscopy. The eyes of the mice with experimental autoimmune uveitis (EAU) were enucleated 18 days after injection and classified according to pathological characteristics.

RESULTS

The characteristics of uveitis were classified into six categories. Macular edema was detected in 48 eyes (61.5%); macular epiretinal membrane in 22 eyes (28.2%); choroidal neovascularization and macular lamellar holes in 4 eyes (5.1%), respectively; macular atrophy in 10 eyes (12.8%); and serous neuroepithelium detachment in 22 eyes (28.2%). As in human patients, pathological examinations of mouse EAU showed inflammation, folds, and atrophy of the outer part of the neuroretina, choroidal neovascularization with hemorrhagic retinal detachment, serous neuroepithelium detachment, and epiretinal membrane formation.

CONCLUSIONS

Macular OCT of uveitis patients can display different morphological characteristics. Mouse EAU can simulate human uveitis. The comparative analysis of macular OCT in human uveitis and transfer EAU histopathology changes could provide important information on the pathogenesis of human uveitis.

Retinal imaging in uveitis

Ancillary investigations are the backbone of uveitis workup for posterior segment inflammations. They help in establishing the differential diagnosis and making certain diagnosis by ruling out certain pathologies and are a useful aid in monitoring response to therapy during follow-up. These investigations include fundus photography including ultra wide field angiography, fundus autofluorescence imaging, fluorescein angiography, optical coherence tomography and multimodal imaging. This review aims to be an overview describing the role of these retinal investigations for posterior uveitis.

Optical coherence tomography in the diagnosis and management of uveitis

Optical coherence tomography (OCT) has become an integral tool in the imaging of numerous diseases of the posterior segment. The diagnostic investigation of infectious and noninfectious uveitic conditions often requires multiple imaging modalities in the appropriate clinical context. Modern OCT technology has proved useful not only in the diagnostic investigation of these conditions, but also in monitoring of their clinical course and therapeutic response. Inflammation-induced changes at the level of the retina, retinal pigment epithelium, and choroid can now easily be identified in these conditions using OCT. Prognostic information on visual acuity outcome can also be estimated based on OCT findings. Numerous OCT findings have been described in the setting of the various uveitides. Although none of these findings appear to be pathognomonic for diagnosis of specific uveitic syndromes, in the appropriate clinical context they can add a great deal of information in the diagnosis and management of uveitis.