Use of optical coherence tomography in the diagnosis and management of uveitis

Diagnosing and Managing Uveitis Associated with Immune Checkpoint Inhibitors: A Review

This review aims to provide an understanding of the diagnostic and therapeutic challenges of uveitis associated with immune checkpoint inhibitors (ICI). In the wake of these molecules being increasingly employed as a treatment against different cancers, cases of uveitis post-ICI therapy have also been increasingly reported in the literature, warranting an extensive exploration of the clinical presentations, risk factors, and pathophysiological mechanisms of ICI-induced uveitis. This review further provides an understanding of the association between ICIs and uveitis, and assesses the efficacy of current diagnostic tools, underscoring the need for advanced techniques to enable early detection and accurate assessment. Further, it investigates the therapeutic strategies for ICI-related uveitis, weighing the benefits and limitations of existing treatment regimens, and discussing current challenges and emerging therapies in the context of their potential efficacy and side effects. Through an overview of the short-term and long-term outcomes, this article suggests recommendations and emphasizes the importance of multidisciplinary collaboration between ophthalmologists and oncologists. Finally, the review highlights promising avenues for future research and development in the field, potentially informing transformative approaches in the ocular assessment of patients under immunotherapy and the management of uveitis following ICI therapy.

Imaging of iris vasculature: current limitations and future perspective

Fluorescein and indocyanine green angiography have been the traditional ways to image the vasculature of the iris in the last few decades. Because of the invasive nature of these procedures, they are performed in rare situations, and thus, our understanding about iris vasculature is very limited. Optical coherence tomography angiography (OCTA) is a noninvasive imaging method that enables the detailed visualization of the retinal and choroidal vascular networks. More recently, it has been also used for the examination of the iris vasculature in healthy and disease eyes. However, there is a lack of uniformity in the image acquisition protocols and interpretations in both healthy and pathological conditions. Artifacts of iris OCTA include shadowing, motion, segmentations errors, mirror effects. OCTA devices have an eye-tracking system designed for the posterior segment and the applications of these systems on the anterior segment can determine motion lines, vessel duplication, and vessel discontinuity. OCTA of the iris should always be performed under ambient room lighting to create miosis and reduce iris vasculature changes during the examination. In the near future, eye-tracking systems specifically designed for the iris vessels could permit the follow-up function, and the development of new OCTA metrics could reveal interesting applications of this new imaging technique.

Subretinal fluid in eyes with active ocular toxoplasmosis observed using spectral domain optical coherence tomography

PURPOSE

To describe the clinical finding of subretinal fluid (SRF) in the posterior pole by spectral domain optical coherence tomography (SD-OCT) in eyes with active ocular toxoplasmosis (OT).

DESIGN

Retrospective case series.

PARTICIPANTS

Thirty-nine eyes from 38 patients with active OT [corrected]..

METHODS

Eyes with active OT which underwent SD-OCT were reviewed. SRFs in the posterior pole were further analyzed.

MAIN OUTCOME MEASURES

Presence of SRF; its accompanying features, e.g. retinal necrosis, cystoid macular edema (CME), choroidal neovascularization (CNV); and longitudinal changes of SRF, including maximum height and total volume before and after treatment.

RESULTS

SRF presented in 45.5% (or 15/33) of eyes with typical active OT and in 51.3% (or 20/39) of eyes with active OT. The mean maximum height and total volume of SRF were 161.0 (range: 23-478) µm and 0.47 (range: 0.005-4.12) mm3, respectively. For 12 eyes with SRF related to active retinal necrosis, SRF was observed with complete absorption after conventional anti-toxoplasmosis treatment. The mean duration for observation of SRF clearance was 33.8 (range: 7-84) days. The mean rate of SRF clearance was 0.0128 (range: 0.0002-0.0665) mm3/day.

CONCLUSIONS

SRF (i.e., serous retinal detachment) is a common feature in patients with active OT when SD-OCT is performed. The majority of SRF was associated with retinal necrosis and reacted well to conventional therapy, regardless of total fluid volume. However, SRF accompanying with CME or CNV responded less favorably or remained refractory to conventional or combined intravitreal treatment, even when the SRF was small in size.

Inflammatory Papillitis in Uveitis: Response to Treatment and Use of Optic Nerve Optical Coherence Tomography for Monitoring

PURPOSE

To describe the clinical course of uveitis-associated inflammatory papillitis and evaluate the utility and reproducibility of optic nerve spectral domain optical coherence tomography (SD-OCT).

METHODS

Data on 22 eyes of 14 patients with uveitis-related papillitis and optic nerve imaging were reviewed. SD-OCT measure reproducibility was determined and parameters were compared in active vs. inactive uveitis.

RESULTS

Papillitis resolution lagged behind uveitis resolution in three patients. For SD-OCT measures, the intraclass correlation coefficients were 99.1-100% and 86.9-100% for intraobserver and interobserver reproducibility, respectively. All SD-OCT optic nerve measures except inferior and nasal peripapillary retinal thicknesses were significantly higher in active vs. inactive uveitis after correction for multiple hypotheses testing. Mean optic nerve central thickness decreased from 545.1 to 362.9 µm (p = 0.01).

CONCLUSIONS

Resolution of inflammatory papillitis can lag behind resolution of uveitis. SD-OCT assessment of papillitis is reproducible and correlates with presence vs. resolution of uveitis.