OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN PATIENTS WITH NONOCULAR BEHÇET DISEASE

Comparative analysis of optical coherence tomography angiography (OCTA) results between Behçet's disease patients and a healthy control group

PURPOSE

This study aimed to compare optical coherence tomography angiography (OCTA) findings between patients with Behçet's disease (BD) and individuals with healthy eyes.

DESIGN

A cross-sectional study.

METHODS

This cross-sectional study was conducted on patients (67 eyes) with BD who were referred to Feiz Hospital and healthy eyes (43 eyes). All subjects underwent Snellen visual acuity, a slit-lamp examination, measuring intraocular pressure, conducting a dilated fundus examination, OCTA imaging, and spectral-domain (SD)-OCT imaging. OCTA retinal vascular measurements including optic nerve VD, macular-associated VD( superficial and deep), foveal avascular zone (FAZ) area, FAZ perimeter (PERIM), and vessel density within a 300-μm-wide region of the FAZ (FD) were compared between the groups.

RESULTS

A significant difference was evident between the two groups (healthy one group and BD group) in terms of parafoveal and perifoveal total retinal thickness, total pRNFL VD in all quadrants except the inferior sector (P < 0.05), and macular superficial, and deep VD in all regions except temporal and superior perifoveal VD (P < 0.05) following adjustments for age, gender, and signal strength index. When comparing the two groups, ocular Behçet's disease (BD) and non-ocular BD, it was evident that peripapillary vessel density (VD) exhibited a significant decrease in ocular BD eyes in all sectors except for the superior and inferior ones, as compared to non-ocular BD eyes. In addition, the comparison of ocular BD and non-ocular BD showed superficial and deep VDs were lower in ocular BD than non-ocular BD in all regions.

CONCLUSION

According to these findings, peripapillary and macular vessel density is affected in BD. Key Points • The study utilized OCTA to compare retinal features in Behçet's disease (BD) patients and healthy individuals, revealing significant differences in retinal thickness and vessel density. • Ocular BD demonstrated reduced peripapillary vessel density compared to non-ocular BD. • The demonstrated association between ADMA and cIMT in patients with early SSc may suggest a role of NO/ADMA pathway in the initiation of macrovascular injury in SSc.

Behçet's disease uveitis

Uveitis in Behçet's disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior or panuveitis. It is non-granulomatous. Uveitis may be the first sign of the disease in 20% of cases or it may appear 2 or 3 years after the first symptoms. Panuveitis is the most common presentation and is more commonly found in men. Bilateralisation usually occurs on average 2 years after the first symptoms. The estimated risk of blindness at 5 years is 10-15%. BD uveitis has several ophthalmological features that distinguish it from other uveitis. The main goals in the management of patients are the rapid resolution of intraocular inflammation, prevention of recurrent attacks, achievement of complete remission, and preservation of vision. Biologic therapies have changed the management of intraocular inflammation. The aim of this review is to provide an update previous article by our team on pathogenesis, diagnostic approaches, identification of factors associated with relapse and the therapeutic strategy of BD uveitis.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BIOMARKERS AND MICROPERIMETRY FEATURES IN BEHÇET'S UVEITIS

PURPOSE

To evaluate the parafoveal macular microvasculature and the macular function in patients with retinal vasculitis associated with Behçet's uveitis.

METHODS

In 14 patients with inactive Behçet's uveitis and 26 control individuals (13 with nonocular Behçet's syndrome and 13 healthy subjects), we analyzed the retinal nerve fiber layer, ganglion cell layer, full retinal thickness, foveal avascular zone area and sectorial parafoveal vascular density in the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus using SPECTRALIS optical coherence tomography (OCT) 2 and OCT angiography. Macular sensitivity was analyzed using an MP-3 microperimeter.

RESULTS

Eighteen eyes (78%) had a best-corrected visual acuity ≥ 20/25. Significant differences were found in Behçet's uveitis in comparison with the controls on the OCT and OCT angiography: 14.8%, 22.4%, and 14.9% ganglion cell layer thinning in the global, nasal, and inferior sectors, respectively; 6%, 13.2%, and 7.5% full retinal thickness thinning in the superior, nasal, and inferior sectors; and 16.8%, 14.9%, 23.6%, 15.8%, and 12.6% mean deep capillary plexus density reduction in the global, superior, nasal, inferior, and temporal sectors. Microperimetry data demonstrated significant mean reductions of 21% and 23.6% in central and average macular sensitivities and 28.8%, 40.4%, 27.7%, and 24.2% in the superior, nasal, inferior, and temporal sectors, respectively. Outer plexiform layer elevations were observed in Behçet's uveitis (69.6%).

CONCLUSION

Behçet's uveitis presented structural and functional macular damage despite good best-corrected visual acuity, mainly affecting the nasal sector and the deep capillary plexus. On OCT and OCT angiography, quantitative and qualitative changes can be valuable biomarkers of ocular involvement in Behçet's syndrome.

Behçet's Disease Uveitis

Uveitis in Behçet's disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior, or panuveitis. Uveitis may be the first sign of the disease in 20% of cases or it may appear 2 or 3 years after the first symptoms. Panuveitis is the most common presentation and is more commonly found in men. Bilateralization usually occurs on average 2 years after the first symptoms. The estimated risk of blindness at 5 years is 10-15%. BD uveitis has several ophthalmological features that distinguish it from other uveitis. The main goals in the management of patients are the rapid resolution of intraocular inflammation, the prevention of recurrent attacks, the achievement of complete remission, and the preservation of vision. Biologic therapies have changed the management of intraocular inflammation. The aim of this review is to provide an update to a previous article by our team on pathogenesis, diagnostic approaches, and the therapeutic strategy of BD uveitis.

ANALYSIS OF VASCULAR CHANGES OF FUNDUS IN BEHCET UVEITIS BY WIDEFIELD SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND FUNDUS FLUORESCEIN ANGIOGRAPHY

PURPOSE

To investigate vascular changes of fundus in quiescent Behçet uveitis (BU) based on widefield swept source optical coherence tomography angiography and fluorescein angiography (FA).

METHOD

This case-control study included 33 patients with quiescent BU (57 eyes)and 35 healthy people (60 eyes) as the control. All participants underwent the widefield swept source optical coherence tomography angiography, and patients with BU additionally underwent the FA. The quantitative analysis of the widefield swept source optical coherence tomography angiography assessed the vessel density of nine anatomical locations in the fundus. Vascular leakage and retinal nonperfusion on FA were assessed in patients with BU.

RESULTS

Compared with the control group using Mann-Whitney U test, patients with BU had enlargement of foveal avascular zone ( P = 0.005, P = 0.04, respectively) and decreased vessel density within a 300 µ m width around the foveal avascular zone ( P = 0.001, P < 0.0001, respectively) both in the superficial and deep retina. Larger foveal avascular zone size and lower 300 µ m width around the foveal avascular zone were correlated with higher logarithm of the minimum angle of resolution best-corrected visual acuity in BU ( P ≤ 0.003, P < 0.0001, respectively). Vessel density of choriocapillaris, as the most widely involved of all layers of the retina and choroid, was lower in six locations ( P ≤ 0.03-0.0001) in the peripheral fundus of BU compared with the controls. Vascular leakage and retinal nonperfusion in the peripheral fundus were observed in 54.4% and 66.7% of the patients on FA.

CONCLUSION

Fovea and peripheral fundus were prone to the damage of ischemia as evidenced by significantly decreased vessel density of capillaries. Combination of swept source optical coherence tomography angiography with FA could accurately evaluate the changes in the retinal and choroidal vasculature in BU.

Outcome Measures for Disease Monitoring in Intraocular Inflammatory and Infectious Diseases (OCTOMERIA): Understanding the Choroid in Uveitis with Optical Coherence Tomography (OCT)

PURPOSE

To compare imaging modalities for the choroid of the eye, and evaluate various choroidal changes in uveitides entities.

METHODS

A comprehensive systematic literature review was conducted looking at current imaging modalities available to assess choroid architecture and commonly used parameters available to qualify and quantify choroidal changes, before looking at specific uveitides entities with choroidal involvement which have been broadly separated into non-infectious and infectious in etiology.

RESULTS

We describe the various modalities currently available to evaluate the choroid of the eye such as Ultrasound B Scan, ICGA, and OCT. Choroidal changes in various ocular and systemic diseases such as Behcet's Disease, Sarcoidosis, Syphillis, Tuberculosis, and many more have been reported and published.

CONCLUSION

Multiple choroidal tomographic and angiotomographic findings have been demonstrated for evaluation in uveitis. These findings can manifest in multiple ocular and systemic diseases, and can be illustrated using the various imaging modalities at present. Future advancements in choroidal imaging would help to adapt these findings into parameters for clinical practice to properly evaluate these ocular and systemic diseases.

Retinal vascular assessment in psoriatic patients with and without metabolic syndrome using optical coherence tomography angiography

To evaluate the retinal vasculature in psoriasis patients and detect if metabolic syndrome is an additional risk factor. This cross-sectional analytic study was carried out on 80 eyes of 80 subjects; 28 eyes with psoriasis only (PS group), 12 eyes with additional metabolic syndrome to psoriasis (PMS group) and 40 eyes healthy controls (HS). The retinal capillary plexuses were evaluated by OCTA. The disease activity was evaluated by the Psoriasis Area and Severity Index (PASI) score and extent. The superficial capillary plexus (SCP) vascular density was significantly lower in PS group than HS while in PMS it was significantly lower only in whole image and superior and temporal perifoveal areas (p-value = 0.020, 0.030, 0.001 respectively). The changes correlated with the disease duration. The vascular density of the deep capillary plexus (DCP) was significantly lower in both PS and PMS groups (p-value < 0.001). Psoriatic patients are at a higher risk of developing retinal vascular complications even without evident clinical ocular disease. It was noted that the presence of metabolic syndrome contributes as an additional risk factor in possible visual loss secondary to ischemic changes that are likely to start in the DCP and progress to involve all levels.

Retinal and choroidal microvascular alterations in Behcet’s disease without ocular manifestations: A systematic review and meta-analysis

Purpose

We performed a systematic review and meta-analysis to examine the microvascular alterations in non-ocular Behcet’s disease (BD) using optical coherence tomography angiography (OCTA).

Methods

A comprehensive search was performed in Pubmed, Embase and Cochrane databases for eligible studies from inception to February 2022. Detailed clinical demographics were extracted from each study by two independent reviewers. The weighted mean difference (WMD) and 95% confidence intervals (CI) were used to compare the OCTA parameters between non-ocular BD and healthy controls. Stata 12.0 was adopted to conduct statistical analyses.

Results

Ten cross-sectional studies involving 386 eyes in non-ocular BD and 418 eyes in healthy volunteers were ultimately included in the present analysis. When considering superficial capillary plexus (SCP) and deep capillary plexus (DCP), no significant differences of vessel densities in the whole enface image, fovea and perifovea were evaluated between two groups. Significantly reduced parafoveal vessel density of SCP was observed in non-ocular BD in comparison with healthy group (WMD = −1.33, 95%CI: −1.78, −0.89; I2 = 0.6%), while slightly decreased parafoveal vessel density was assessed in DCP (WMD = −1.47, 95%CI: −3.30, 0.35; I2 = 89.3%). Significantly increasing foveal avascular zone (FAZ) area was observed in non-ocular BD when compared to healthy controls (WMD = 0.11, 95%CI: 0.03, 0.19; I2 = 95.3%). There was no significant difference in flow area of choriocapillaris between non-ocular BD and control group (WMD = 0.06, 95%CI: −0.19, 0.32; I2 = 0%).

Conclusion

Based on current analysis, our results demonstrated significantly lower parafoveal vessel density of SCP and lager FAZ area in full vasculature in non-ocular BD. The retinal microvascular alterations appear before the emergence of ocular manifestations.

Systematic Trial Registration

[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021244856].

Evaluation of retinal and choroidal microcirculation in Behçet's disease

PURPOSE

To investigate retinal perfusion by optical coherence tomography (OCT)-angiography and choroidal vascular features using an OCT-based image binarization method in patients with Behçet's disease (BD) without clinical ocular involvement.

METHODS

This study included 38 patients with non-ocular BD and 35 healthy participants. Macular region was evaluated with OCT-angiography (Optovue, Inc., Fremont, CA). A 6.0 × 6.0 mm rectanglescan centred on the fovea was used to record the scans. The enhanced depth imaging OCT scans (Heidelberg Eye Explorer version 1.8.6.0; Heidelberg Engineering) of the macula and peripapillary scans of the optic nerve head were binarized using ImageJ software (National Institutes of Health, Bethesda, MD, USA). The luminal area (LA), stromal area (SA), total choroidal area (TCA), and choroidal thickness (CT) were analysed. The choroidal vascularity index (CVI) was calculated as the ratio of the LA to the TCA.

RESULTS

Vessel density values of the superficial and deep macular capillary plexus were similar between the two groups (all p > 0.05). There was no significant difference between the groups in terms of the CT and TCA values in the macula and in all peripapillary sectors (all p > 0.05). However, the macula and temporal, nasal, and inferior sectors of the peripapillary area had significantly lower CVI values in the BD group compared with controls (p = 0.009, p = 0.002, p = 0.010, and p = 0.008, respectively).

CONCLUSIONS

Retinal microperfusion deficit was not observed in non-ocular Behçet patients. CVI may be a more robust marker than CT to indicate choroidal perfusion. A reduced CVI may suggest subclinical ocular involvement and choroidal ischemia in these patients.

Quantitative changes in peripapillary, macular, and choriocapillaris microvasculatures of patients with non-ocular Behçet's disease and relationship with systemic vascular involvement, an optical coherence tomography angiography study

BACKGROUND

To evaluate the changes in the peripapillary, macular and choriocapillaris microvasculatures in the eyes of patients with Behçet's disease (BD) without ocular involvement by optical coherence tomography angiography (OCT-A) and to investigate the relationship with systemic vascular involvement (SVI).

METHODS

The study included 56 eyes of 33 patients with non-ocular BD and 61 eyes of 33 healthy subjects. The macular microvascular (MMV) vessel densities (VDs), FAZ parameters, Choriocapillaris flow area (CCFA), radial peripapillary capillary (RPC) VDs and optic nerve head (ONH) analyses were performed with OCT-A. MMV, RPC, ONH, and CCFA measurements were compared between the non-ocular BD patients and healthy controls. Then, the patient group was divided into two subgroups according to the presence of SVI. MMV, RPC, and CCFA measurements of these subgroups were compared with the healthy controls.

RESULTS

While deep capillary plexus VD and foveal density decreased in MMV analysis in the BD group compared to the control group, CCFA was not different. In the RPC and ONH analysis, the VDs of the inside-disc small vessels and the VDs of the inside-disc all vessels were decreased while the cup/disk area ratio and cup volume were increased in the BD group compared to the healthy controls. Furthermore, the VDs of the inside-disc vessels were reduced in patients without SVI compared to those with SVI and healthy controls.

CONCLUSIONS

The RPC network, ONH and MMV architecture analysis by OCT-A revealed changes in the MMV, RPC, and ONH structures in non-ocular BD patients. Moreover, the decrease in RPC VDs and MMV VDs in patients without SVI suggested that the patients with BD without SVI had subclinical ocular involvement even in the absence of clinical ocular findings.

Optical coherence tomography angiography of subclinical ocular features in pediatric Behçet disease

PURPOSE

To investigate macular and optic nerve head (ONH) vascular density (VD), foveal avascular zone (FAZ) area, choroidal thickness, outer retina and choriocapillaris flow, and morphological changes of foveal microvasculature in pediatric Behçet disease (BD) without ocular involvement using optical coherence tomography angiography (OCTA).

METHODS

We analyzed 22 eyes of 22 pediatric patients diagnosed with BD without ocular involvement and 24 age- and sex-matched healthy controls in this prospective, cross-sectional study. The superficial capillary plexus (SCP) and the deep capillary plexus (DCP), FAZ parameters, the flow area of the outer retina, and choriocapillaris were evaluated using OCTA.

RESULTS

Vessel density of the whole image, fovea, parafovea, and perifovea in DCP were significantly lower in the nonocular pediatric BD group (P = 0.008, P = 0.038, P = 0.046, and P = 0.008, resp.). There was no significant difference between the groups in VD parameters of both SCP and ONH, as well as FAZ parameters (P > 0.05 for all). Although outer retina and choriocapillaris flow area at 1 mm, 2 mm, and 3 mm radius were lower in the nonocular pediatric BD group than in the control group, the difference was statistically significant only in the outer retina flow area at 3 mm radius (P = 0.011).

CONCLUSIONS

In this cohort of pediatric nonocular BD patients, there was decreased vessel density in the DCP and decreased outer retinal flow. Hence, OCTA can reveal microvascular changes in patients without detectable ocular involvement.

Retinal microvasculature features in patients with Behcet's disease: a systematic review and meta-analysis

This meta-analysis aimed to analyze retinal microvasculature features in eyes with Behçet's disease (BD) using optical coherence tomography angiography (OCTA). Electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, were comprehensively searched for published studies comparing retinal microvasculature characteristics between eyes with BD and controls. Continuous variables were calculated using the mean difference (MD) with 95% confidence interval (CI). Review Manager software (version 5.30) was used to conduct statistical analysis. A total of 13 eligible studies involving 599 eyes with BD and 622 control eyes were included in the meta-analysis. The pooled results showed that the macular whole enface superficial and deep vessel density (VD) values measured by OCTA were significantly lower in eyes with BD than in control eyes (superficial VD: MD = - 3.05, P < 0.00001; deep VD: MD = - 4.05, P = 0.0004). The foveal superficial and deep VD values were also significantly lower in the BD group than in the control group (superficial VD: MD = - 1.50, P = 0.009; deep VD: MD = - 4.25, -  = 0.03). Similarly, the analysis revealed a significant reduction in the parafoveal superficial and deep VD in eyes with BD than in control eyes (superficial VD: MD =  - 3.68, P < 0.00001; deep VD: MD = - 4.95, P = 0.0007). In addition, the superficial and deep foveal avascular zones (FAZs) were significantly larger in patients with BD than in controls (superficial FAZ: MD = 0.06, P = 0.02; deep FAZ: MD = 0.12, P = 0.03). The present meta-analysis found that macular whole enface VD, foveal VD, and parafoveal VD were lower in eyes with BD, and the FAZ was larger in patients with BD. The findings suggest that OCTA can assist clinicians in diagnosing and monitoring the status of patients with BD.

Visual outcomes and choroidal thickness associated with human leukocyte antigen DRB1*04 in unclassifiable uveitis in Japanese patients

Purpose

Human leukocyte antigen (HLA) and immunity are related. Uveitis is also closely related to immunity. For example, the common presence of human leukocyte antigen (HLA)-DRB1*04 in the immune response is well known. The aim of this study was to investigate the relationship between visual prognosis and various HLA alleles before and after therapy in patients with unclassifiable uveitis, excluding those with Vogt-Koyanagi-Harada (VKH) disease.

Methods

This retrospective case series included 42 eyes from 22 consecutive patients with unclassifiable uveitis, excluding those with VKH disease. Visual acuity (VA), sex, refractive error, central retinal thickness (CRT), central choroidal thickness (CCT), and duration from onset to treatment were measured at initial and 6-month visits. Mean values of parameters were compared at each visit. Genotyping was performed by polymerase chain reaction amplification with sequence-specific primers.

Results

DRB1*04 showed a dominant change. No significant difference was observed in the other alleles. In DRB1*04, The mean differences in initial CCT, 6-month CCT, and 6-month VA showed statistically significant difference was found in best-corrected visual acuity (BCVA) between DRB1*04+ and DRB1*04− at the first visit. BCVA values at baseline and at the final visit were 0.13 ± 0.29 and 0.20 ± 0.36 in the DRB1*04+ and 0.00045 ± 0.20 and − 0.058 ± 0.11 in the DRB1*04− groups(p = 0.00465). Central Choroidal Thickness (CCT) values pretreatment and at the final visit after treatment were (pretreatment:361.00 ± 361.0 μm,after treatment: 286.00 ± 106.53 μm, p = 0.0174) in the DRB1*04+ group, and (pretreatment:281.3 ± 139.68 μm,after treatment:223.85 ± 99.034 μm, p = 0.0426) in the DRB1*04− group, respectively, indicating changes between baseline and the final visit. CCT was significantly greater in the DRB1*04+ group at both the initial visit and at 6 months. Multivariate analysis showed a significant difference between the presence or absence of DRB1*04 and sex.

Conclusion

HLA-DRB1*04 allele may affect visual prognosis and CCT in unclassifiable uveitis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-02222-9.

Preclinical ocular features in patients with Behçet's disease detected by optical coherence tomography angiography

OBJECTIVE

The aim of this study was to evaluate the perifoveal and peripapillary microvascular structure in patients with Behçet's disease (BD) without clinically ocular involvement.

METHODS

Fifty-six eyes of 28 patients with Behçet's disease without clinically ocular involvement and 50 age-matched healthy eyes were included in this prospective study. Vessel densities (VD) of macula and optic nerve head, foveal avascular zone (FAZ), choroid capillary plexus (CCP) flow area, perifoveal capillary nonperfusion, capillary dilatation and/or telangiectasia and perifoveal capillary arcade disruption were analyzed with optical coherence tomography angiography (OCTA). The relationship between duration of disease and vessel densities was also evaluated.

RESULTS

The FAZ was significantly higher in the BD group (p < 0.001). VD of the foveal and parafoveal region in deep capillary plexus (DCP) were significantly lower in the BD group than in the control group (p < 0.001, p < 0.001). Total disc, peripapillary and inside-disc VD were significantly lower in BD group (p = 0.001, p = 0.002, p = 0.004). Perifoveal morphological changes in DCP were significantly higher in nonocular BD (p < 0.001, p < 0.001, p < 0.001). There was a mild negative correlation between disease duration and whole VD in DCP, total disc VD, peripapillary VD was determined (For whole VD in DCP, r = -0.400, p = 0.035; for total disc VD r = -0.396, p = 0.037; for peripapillary VD r = -0.442, p = 0.018).

DISCUSSION

Perifoveal and peripapillary microvascular changes that can be detected by OCTA may occur in Behçet's patients without clinically ocular involvement.

Parafoveal Microvascular Alterations in Ocular and Non-Ocular Behҫet's Disease Evaluated With Optical Coherence Tomography Angiography

Purpose

To compare quantitative optical coherence tomography angiography (OCT-A) measurements of the parafoveal microvasculature in retinal capillary plexuses among Behҫet uveitis (BU) patients, non-ocular Behҫet's disease (NOBD) patients, and healthy volunteers (HVs).

Methods

Sixty-eight subjects were enrolled in this prospective observational cross-sectional study. OCT-A imaging was performed using the Heidelberg Engineering Spectralis OCT. A custom algorithm was developed to calculate the vessel density (VD) in three retinal vascular layers: deep capillary plexus, intermediate capillary plexus, and superficial vascular plexus. The foveal avascular zone (FAZ) and acircularity index were calculated for the whole retinal vascular complex.

Results

We analyzed one eye from 21 BU patients (age, 51 ± 10 years), 23 NOBD patients (age, 48 ± 14 years), and 22 HVs (age, 44 ± 13 years). One-way multivariate analysis of covariance showed a statistically significant difference in VD among the three groups when combining the layers after controlling for scan quality (P < 0.001). The VD was lowest in the BU group and highest in the HV group in all layers. The FAZ area was also statistically significant different among the groups (P < 0.005), with the largest FAZ areas in BU patients and smallest FAZ areas in the HV group. However, no statistically significant difference was found for the acircularity index.

Conclusions

The parafoveal microvasculature is affected not only in BU patients but also in NOBD patients. Most deviations in the retinal microcirculation in Behҫet patients were found in the deeper layers of the retina by using the quantitative VD measurement.

Old and New Challenges in Uveitis Associated with Behçet's Disease

Behçet’s disease (BD) is a systemic vasculitis disease of unknown origin occurring in young people, which can be venous, arterial or both, classically occlusive. Ocular involvement is particularly frequent and severe; vascular occlusion secondary to retinal vasculitis may lead to rapid and severe loss of vision. Biologics have transformed the management of intraocular inflammation. However, the diagnosis of BD is still a major challenge. In the absence of a reliable biological marker, diagnosis is based on clinical diagnostic criteria and may be delayed after the appearance of the onset sign. However, therapeutic management of BD needs to be introduced early in order to control inflammation, to preserve visual function and to limit irreversible structural damage. The aim of this review is to provide current data on how innovations in clinical evaluation, investigations and treatments were able to improve the prognosis of uveitis associated with BD.

Quantitative Evaluation of the Retinal Vascular Parameters With OCTA in Patients With Behçet Disease Without Ocular Involvement

BACKGROUND AND OBJECTIVE

To evaluate the optical coherence tomography angiography (OCTA) features of patients with Behçet disease (BD) without ocular involvement.

PATIENTS AND METHODS

Twenty-three patients with BD without ocular involvement and 29 healthy age/sex-matched control subjects were involved. The authors measured foveal avascular zone (FAZ) area, vessel density in the parafoveal region, and flow area (fovea-centered 3-mm radius area) in the superficial and deep capillary plexuses evaluated by OCTA.

RESULTS

FAZ area was significantly larger in eyes with BD in both the superficial and deep capillary plexuses (0.331 vs. 0.240 mm² [P = .004] and 0.352 vs. 0.257 mm² [P = .003], respectively). Although mean capillary vessel density in parafoveal region and mean flow area were lower in eyes with BD for both superficial and deep capillary plexuses, these findings were not statistically significant.

CONCLUSION

Microvascular changes in macular region can be identified in patients with BD without ocular manifestation. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:31-34.].

Optical coherence tomography angiography (OCTA) as a new diagnostic tool in uveitis

Background

The broad spectrum of uveitis disorders requires a multimodal imaging approach in the daily practice of an ophthalmologist. As inflammatory conditions, they have in common an alteration in leukocyte migration. In this context, optical coherence tomography angiography (OCTA) might be of great value for diagnosing or following up patients with these disorders. To date, OCTA has rather been used as an additional tool besides the well-established diagnostic imaging tools, but its complementary diagnostic features become increasingly relevant, to follow disease activity and treatment response and for the understanding of pathomechanisms of various uveitis types.

This review summarizes the possible applications of OCTA and its advantages and disadvantages as opposed to dye-based angiographies in uveitic diseases.

Main body

Hitherto gold standards in the diagnostic workup of posterior or intermediate uveitis have been angiography on a dye-based method, which is fluorescein or indocyanine green. It gives information about the status of the blood-retinal barrier and the retinal and choroidal vasculature by visualizing diffuse leakage as a state of inflammation or complications as an ischemia or choroidal neovascularization. As noninvasive methods, fundus autofluorescence depicts the status of metabolic activity of the retinal pigment epithelium and OCT or enhanced depth imaging OCT, respectively, as a depth-resolving imaging method can supply additional information.

OCTA as a non-invasive, depth-resolution imaging tool of retinal and choroidal vessels adds detailed qualitative and quantitative information of the status of retinal and choroidal vessels and bridges the gap between the mentioned conventional diagnostic tools used in uveitis.

It is important, though, to be aware of its limitations, such as its susceptibility to motion artifacts, limited comparability among different devices, and restricted contribution of information regarding the grade of disease activity.

Conclusion

OCTA as a non-invasive, depth-resolution imaging tool can give qualitative and quantitative information about the status of retinal and choroidal vessels, but also has certain limitations. Employing OCTA as a complementary rather than exclusive tool, it can give important additional information about the macro- and microvasculature under inflammatory circumstances. Thereby, it also contributes to the understanding of the pathophysiology of various uveitis entities.

Quantitative analysis of retinal microcirculation in optical coherence tomography angiography in cases with Behçet's disease without ocular involvement

PURPOSE

To evaluate the retinal vascular plexus and choriocapillaris structures in patients with non-ocular Behçet's disease (BD) using optical coherence tomography angiography (OCTA).

METHODS

The study included 42 eyes of non-ocular BD patients (study group) and 40 eyes of 20 healthy subjects (control group). Flow area (mm²), mean vascular density (VD) (%) and foveal avascular zone (FAZ) (mm²) were measured using OCTA (Optovue Inc., Fremont, CA, USA). Subfoveal choroidal thickness (CT) (μm) and central macular thickness (CMT) (μm) measurements were also performed.

RESULTS

The mean superficial capillary plexus, deep capillary plexus and choriocapillaris flow area values were found to be significantly lower in the study group than in the control group (p < 0.001, p < 0.001, p = 0.008, respectively). In respect of mean VD, a statistically significant difference was determined between the study and control groups in both superficial and deep VD (p < 0.001). No statistically significant difference was found out between the groups in respect of superficial FAZ, deep FAZ and CMT (p = 0.165, p = 0.477, p = 0.457, respectively). The subfoveal CT was also measured to be significantly thicker in the study group than in the control group (p < 0.001).

CONCLUSION

The results obtained with OCTA revealed that there could be both retinal and choroidal involvement in non-ocular BD patients before the emergence of evident clinical findings.