Retinal and choroidal thickness measurements using spectral domain optical coherence tomography in anterior and intermediate uveitis

The Current and Novel Imaging Modalities for Ocular Vasculitis in Behcet's Disease: A Review

Behcet's syndrome is a multisystem inflammatory disorder characterized by a chronic relapsing course and diverse clinical manifestations, prominently affecting young adults along the ancient Silk Road and beyond. The disease pathogenesis involves complex interactions between genetic predisposition, environmental triggers, and dysregulated immune responses, leading to systemic vasculitis and tissue damage. Ocular involvement, a hallmark of Behcet's Disease (BD), significantly impacts morbidity, with uveitis as a common initial presentation that can progress to severe vision-threatening complications like retinal vasculitis and occlusive disease. This review consolidates current knowledge on ocular manifestations in BD, emphasizing the pivotal role of multimodal imaging in diagnostic evaluation and management. Fundus photography serves as a baseline tool for documenting intraocular lesions and monitoring treatment responses. Fluorescein angiography remains the gold standard for detecting acute inflammatory changes and vascular leakage patterns essential for disease staging and prognostication. Recent advancements in imaging, such as ultra-wide field imaging (UWF), indocyanine green angiography (ICGA), Doppler ultrasonography, Optical Coherence Tomography (OCT), OCT angiography (OCTA), adaptive optics (AO), and retinal function imaging (RFI), provide unprecedented insights into microvascular dynamics, structural changes, and functional impairments associated with ocular BD. Integration of these advanced imaging modalities enhances early detection of subclinical disease, facilitates precise localization of inflammatory lesions, guides therapeutic interventions, and monitors treatment efficacy. OCT and OCTA, in particular, offer non-invasive, high-resolution assessments of macular edema, vascular perfusion abnormalities, and choroidal thickness alterations critical for optimizing patient care. In conclusion, multimodal imaging represents the cornerstone in the comprehensive management of ocular manifestations in Behcet's Disease, offering clinicians invaluable tools for accurate diagnosis, treatment planning, and long-term monitoring of disease progression and treatment outcomes.

Effect of adalimumab on choroidal thickness and choroidal vascularity index in eyes with non-infectious uveitis using enhanced-depth imaging optical coherence tomography

OBJECTIVE

To evaluate the effect of adalimumab (ADA) on choroidal thickness (ChT) and choroidal vascularity index (CVI) in eyes with non-infectious uveitis (NIU).

METHODS

Thirty-seven eyes with NIU including Behçet disease (BD), sarcoidosis, ankylosing spondylitis (AS), juvenile idiopathic arthritis and idiopathic arthritis, 38 eyes of non-uveitic (NU) patients including BD, AS and rheumatoid arthritis, and 40 healthy control eyes were included. ADA was used for anti-TNF-naive adult (80 mg) or paediatric (40 mg) patients with refractory NIU, then 40 mg every 2-week (20 mg in children<30 kg) with controls at weeks 1, 4, 12, and 24. Images were used to measure central, nasal, and temporal ChT, and the luminal area (LA), stromal area, and total choroidal area (TCA) were analysed using enhanced-depth imaging optical coherence tomography (EDI-OCT) by ImageJ software. The CVI was then calculated as the ratio of LA to TCA.

RESULTS

Mean ages were similar between the groups. Mean (SE) subfoveal ChT measurements for each location were also similar (for each, p > 0.05). However, calculated CVI values in eyes with NIU (0.63 ± 0.007) were significantly (p < 0.001) lower than NU eyes (0.66 ± 0.006) and controls (0.70 ± 0.007) (p < 0.001). Moreover, CVI was significantly lower in NU eyes compared to controls (p < 0.001). There were no significant CVI changes between the consecutive visits after ADA therapy in eyes with NIU (for each, p > 0.05).

CONCLUSIONS

Decreased CVI in NIU and NU eyes indicates that systemic inflammation affects the choroidal vasculature and perfusion both in the presence and absence of ocular involvement. Although CVI may be used as a possible novel tool in monitoring ocular involvement and progression of NIU, CVI does not seem to be a biomarker for treatment monitoring in NIU.

Intermediate Uveitis: A Review

PURPOSE

This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU).

METHODS

Narrative literature review.

RESULTS

IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice.

CONCLUSIONS

IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.

Topical Ocular Anti-TNFα Agent Licaminlimab in the Treatment of Acute Anterior Uveitis: A Randomized Phase II Pilot Study

Purpose

Licaminlimab is a new anti-TNFα antibody fragment for topical ocular application. This phase II study assessed the tolerability, treatment effect, and pharmacokinetics of licaminlimab in acute anterior uveitis (AAU).

Methods

In this multicenter, randomized, parallel-group, double-masked study, 43 adult patients with non-infectious AAU and Standardization of Uveitis Nomenclature (SUN) anterior chamber (AC) cell score of 2+ or 3+ were randomized (3:1 ratio) to licaminlimab (60 mg/mL, 8 drops/day for 15 days, 4 drops/day for 7 days, then matching vehicle for 7 days) or dexamethasone eye drops (8 drops/day for 15 days, tapering to 1 drop/day over 14 days). The primary efficacy end point was clinical response (≥2-step decrease in AC cell grade at day 15). A treatment effect was considered as established if the lower limit of the 95% posterior interval of the responder rate was >30%. Serum levels of licaminlimab were determined.

Results

The day 15 response rate for licaminlimab was 56%; the lower bound of the 95% credible interval was 40% (i.e. >30%), demonstrating a treatment effect according to prespecified criteria. By day 4, 36% of licaminlimab-treated patients were responders; 76% had an AC cell grade of 0 on ≥1 post-treatment visit. The day 15 dexamethasone response rate was 90% (no inferential between-arm comparison was planned). Both treatments were well-tolerated. Intraocular pressure increased from baseline with dexamethasone but not licaminlimab. Licaminlimab was undetectable in serum in most patients.

Conclusions

Licaminlimab is the first biologic demonstrated to have a treatment effect on an intraocular condition with topical ocular application. The trial met its primary objective and the observed responder rate for licaminlimab was 56.0%. Ocular administration of licaminlimab was well-tolerated in adult subjects with AAU for up to 35 days.

Changes in Choroidal Vascularity Index (CVI) in Intermediate Uveitis

Purpose

To investigate the longitudinal changes in choroidal vascularity index (CVI) in eyes with active and quiescent intermediate uveitis using enhanced depth imaging optical coherence tomography (EDI-OCT).

Methods

EDI-OCT images of eyes with active and quiescent intermediate uveitis were retrospectively reviewed and binarized using ImageJ software. Choroidal parameters including CVI, total choroidal area (TCA), luminal area (LA), stromal area (SA), and subfoveal choroidal thickness (SCT) were measured and compared between baseline and follow-up visits among eyes with active and quiescent intermediate uveitis.

Results

Thirty-eight eyes from 21 patients with active intermediate uveitis and 30 eyes from 17 patients with quiescent intermediate uveitis were included. CVI in eyes with active intermediate uveitis significantly increased from baseline (66.50% ± 3.40%) with resolution of inflammation on follow-up (68.82% ± 3.90%; P < 0.001). In eyes with quiescent intermediate uveitis at baseline eyes, CVI did not significantly change after follow-up (66.34% ± 3.19% to 66.25% ± 3.13%; P = 0.850).

Conclusions

CVI significantly increased when active inflammation in intermediate uveitis resolved while CVI remained unchanged at follow-up in quiescent intermediate uveitis.

Translational Relevance

CVI may be a useful noninvasive tool to monitor treatment response in intermediate uveitis. Our findings also highlight the involvement of choroidal vasculature in uveitic eyes without any clinical evidence of choroiditis.

Altered Functional Connectivity of the Primary Visual Cortex in Patients With Iridocyclitis and Assessment of Its Predictive Value Using Machine Learning

Purpose

To explore the intrinsic functional connectivity (FC) alteration of the primary visual cortex (V1) between individuals with iridocyclitis and healthy controls (HCs) by the resting-state functional magnetic resonance imaging (fMRI) technique, and to investigate whether FC findings be used to differentiate patients with iridocyclitis from HCs.

Methods

Twenty-six patients with iridocyclitis and twenty-eight well-matched HCs were recruited in our study and underwent resting-state fMRI examinations. The fMRI data were analyzed by Statistical Parametric Mapping (SPM12), Data Processing and Analysis for Brain Imaging (DPABI), and Resting State fMRI Data Analysis Toolkit (REST) software. Differences in FC signal values of the V1 between the individuals with iridocyclitis and HCs were compared using independent two-sample t-tests. Significant differences in FC between two groups were chosen as classification features for distinguishing individuals with iridocyclitis from HCs using a support vector machine (SVM) classifier that involved machine learning. Classifier performance was evaluated using permutation test analysis.

Results

Compared with HCs, patients with iridocyclitis displayed significantly increased FC between the left V1 and left cerebellum crus1, left cerebellum 10, bilateral inferior temporal gyrus, right hippocampus, and left superior occipital gyrus. Moreover, patients with iridocyclitis displayed significantly lower FC between the left V1 and both the bilateral calcarine and bilateral postcentral gyrus. Patients with iridocyclitis also exhibited significantly higher FC values between the right V1 and left cerebellum crus1, bilateral thalamus, and left middle temporal gyrus; while they displayed significantly lower FC between the right V1 and both the bilateral calcarine and bilateral postcentral gyrus (voxel-level P<0.01, Gaussian random field correction, cluster-level P<0.05). Our results showed that 63.46% of the participants were correctly classified using the leave-one-out cross-validation technique with an SVM classifier based on the FC of the left V1; and 67.31% of the participants were correctly classified based on the FC of the right V1 (P<0.001, non-parametric permutation test).

Conclusion

Patients with iridocyclitis displayed significantly disturbed FC between the V1 and various brain regions, including vision-related, somatosensory, and cognition-related regions. The FC variability could distinguish patients with iridocyclitis from HCs with substantial accuracy. These findings may aid in identifying the potential neurological mechanisms of impaired visual function in individuals with iridocyclitis.

[Application of high-resolution optical coherence tomography for visualization of eye structures in uveitis of different localization]

The article presents an analysis of publications in main Russian and foreign journals devoted to the use of optical coherence tomography in intravital visualization of the structures of the eye for diagnosis, assessment of the changes during relapses, recovery and remission stages, as well as the effectiveness of treatment for uveitis of different localization. It describes in detail the results of studies conducted using spectral optical coherence tomography, changes in the anterior chamber and cornea in uveitis of the anterior localization, morphological changes in the vitreous body, vitreomacular interface, retina, choroid and optic disc in the anterior and posterior localization of inflammation, and presents the features of OCT diagnosis in a number of nosological forms of uveitis based on the literature data.

Disrupted Neural Activity in Individuals With Iridocyclitis Using Regional Homogeneity: A Resting-State Functional Magnetic Resonance Imaging Study

Objective: This study used the regional homogeneity (ReHo) technique to explore whether spontaneous brain activity is altered in patients with iridocyclitis.

Methods: Twenty-six patients with iridocyclitis (14 men and 12 women) and 26 healthy volunteers (15 men and 11 women) matched for sex and age were enrolled in this study. The ReHo technique was used to comprehensively assess changes in whole-brain synchronous neuronal activity. The diagnostic ability of the ReHo method was evaluated by means of receive operating characteristic (ROC) curve analysis. Moreover, associations of average ReHo values in different brain areas and clinical characteristics were analyzed using correlation analysis.

Result: Compared with healthy volunteers, reduced ReHo values were observed in patients with iridocyclitis in the following brain regions: the right inferior occipital gyrus, bilateral calcarine, right middle temporal gyrus, right postcentral gyrus, left superior occipital gyrus, and left precuneus. In contrast, ReHo values were significantly enhanced in the right cerebellum, left putamen, left supplementary motor area, and left inferior frontal gyrus in patients with iridocyclitis, compared with healthy volunteers (false discovery rate correction, P < 0.05).

Conclusion: Patients with iridocyclitis exhibited disturbed synchronous neural activities in specific brain areas, including the visual, motor, and somatosensory regions, as well as the default mode network. These findings offer a novel image-guided research strategy that might aid in exploration of neuropathological or compensatory mechanisms in patients with iridocyclitis.

Differentiating Multifocal Choroiditis and Punctate Inner Choroidopathy: A Cluster Analysis Approach

PURPOSE

To develop a robust approach to clinical phenotyping of multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC).

DESIGN

Cross-sectional and longitudinal observational study.

METHODS

This multicenter study included sites in the United Kingdom and Israel. The study population included 343 eyes of 185 subjects with hospital record diagnoses of MFC or PIC. Eyes were observed over a period of 5 years for clinically relevant characteristics, including demographics and multimodal imaging features, by observers masked to the original diagnoses. Multivariate 2-step cluster analysis was used to identify clusters of eyes in the database with similar clinical phenotypes, which were then analyzed for between-group differences. The primary outcome measure was the difference between clinical phenotype clusters identified using clinical criteria from the multivariate cluster analysis.

RESULTS

Subjects ranged from 11 to 89 years of age, with a baseline best-corrected visual acuity of 2.3 to -0.2 logarithm of minimal angle of resolution. Eighty-two percent of eyes were from females, 74% were myopic with a refractive error of +3.00 to -17.00 diopters (spherical equivalent). Cluster analysis prioritized clinical criteria of chorioretinal lesion location and intraocular inflammation and identified 2 distinct phenotype clusters resembling the original descriptions of MFC and PIC. During the 5-year period of observation, the initial clinical diagnosis remained stable for most eyes and only 1 eye (0.3%) changed diagnosis from PIC to MFC because of newly developed peripheral lesions. There were significant between-group differences in clinical characteristics, for example, in choroidal neovascular membrane development and treatment received.

CONCLUSIONS

Cluster analysis of this large cohort of eyes identified peripheral lesions and intraocular inflammation as distinct clinical phenotypes of MFC and PIC. The initial diagnosis remained stable for most eyes. This methodology could be useful for future uveitis classification and management.

Characteristics of retinal layer thickness in acute anterior uveitis: an optical coherence tomography study

PURPOSE

To determine the changes in peripapillary retinal nerve fiber layer (pRNFL), macular and ganglion cell-inner plexiform layer (GC-IPL) thicknesses in patients with acute anterior uveitis (AAU).

METHODS

Patients diagnosed with unilateral non-infectious AAU and normal control were enrolled retrospectively. Optical coherence tomography scans were performed during the initial active phase and inactive phase of AAU. Patients were followed for at least 3 months after resolution of inflammatory activity.

RESULTS

Thirty-seven AAU patients and 40 controls were included. The average RNFL and central macular thickness (CMT) showed significant differences between patients and control groups during active phase (p < 0.001 and p = 0.022, respectively). The average pRNFL thicknesses of affected eyes and fellow eyes during the active phase were 109.4 ± 12.5 μm and 96.5 ± 8.0 μm, respectively (p < 0.001). During the inactive phase, the average thicknesses were 99.3 ± 8.9 μm and 97.0 ± 7.5, respectively; they were not significantly different (p = 0.236). The CMTs of affected and fellow eyes during the active phase were 261.6 ± 24.7 μm and 251.5 ± 17.3 μm, respectively; the difference was significant (p = 0.047). The average GC-IPL thicknesses of affected and fellow eyes were not significantly different (p = 0.061).

CONCLUSIONS

The pRNFL and central macula thickened during the active phase of AAU and decreased to a similar degree with fellow eyes during the inactive phase. Additionally, pRNFL thickness showed a sensitive response to the degree of inflammation in AAU. This suggests that pRNFL thickness may be useful in assessing disease activity.

Role of choroidal thickness assessment in unilateral acute anterior uveitis

Purpose:

The aim of our study was to investigate the change in the subfoveal choroidal thickness in unilateral acute anterior uveitis with treatment. Choroidal inflammation is uncommon but can occur in the acute stage of anterior uveitis.

Methods:

All diagnosed patients with the first episode of unilateral acute anterior uveitis were included in the study conducted for a period of July 2017–July 2018. Choroidal thickness at subfoveal region was measured with spectralis spectral domain optical coherence tomography using enhanced depth-imaging scans. Standardized, masked manual measurement of the choroidal thickness was performed in the center of the ETDRS fields. The unaffected fellow eye of the same patient was taken as a control group and their subfoveal choroidal thickness was measured. Follow up of the patients was done at 2 weeks posttreatment to reevaluate the choroidal thickness.

Results:

A total of 61 eyes of 61 patients with unilateral acute anterior uveitis were included in the study. The mean central subfoveal choroidal thickness was significantly higher (304.82 ± 73.17 μm) as compared to that of controls (251.28 ± 66.38 μm) at presentation (P < 0.001). Following treatment and at two weeks follow up, the subfoveal choroidal thickness significantly reduced from 304.82 ± 73.17 to 274.46 ± 63.82 μm (P < 0.001). Also the subfoveal choroidal thickness was positively correlated with visual acuity (r = 0.22, P < 0.251) before treatment.

Conclusion:

Acute anterior uveitis is associated with an increase in the subfoveal choroidal thickness followed by the significant decrease in choroidal thickness with treatment, suggesting that choroid is also inflamed along with anterior segment inflammation.

Choroidal changes after intravitreal injection of interferon alpha-2b

Intravitreal injection of interferon alpha-2b (IFN-α2b) is used to treat uveitis but its effect on the choroid is unknown. We histologically evaluated the choroidal changes after intravitreal injection of IFN-α2b. We compared histological samples of IFN-α2b-injected eyes to eyes with lipopolysaccharide (LPS)-induced uveitis and eyes injected with balanced salt solution (BSS) as controls. Rabbit eyes received intravitreal injections of BSS, IFN-α2b, or LPS, and enucleation was done seven days later. Choroidal changes were evaluated on histological cut sections. The thickness of the choroid was measured in micrometer and the severity of inflammation was scored. The mean maximum choroidal thickness was significantly greater in the IFN-α2b group in comparison to the LPS and BSS groups ( P < 0.001). The mean minimum choroidal thickness was also significantly greater in the IFN group compared to the BSS group ( P = 0.009). The observed changes were mainly due to vasodilation rather than interstitial fluid retention or inflammation. Mild inflammatory cell infiltration was observed in the choroid of four eyes in the IFN group and of three eyes in the LPS group. No inflammation was seen in the control group. The difference in inflammatory cell infiltration between the LPS and IFN groups was not statistically significant. Significant choroidal hyperemia was present after injection of IFN-α2b. This fact may suggest for some pharmacological applications of IFN-α2b when increased choroidal circulation is needed. However, further studies are required to elucidate the mechanisms involved.

Impact statement

Type I interferons are proteins that are naturally secreted by cells in response to certain stimuli. They are approved for medical use to regulate immune responses in many disease states. Our findings of increased choroidal circulation after treatment of the eye with interferon alpha-2b indicate a possible effect of this cytokine on blood circulation. This is a novel finding that needs further investigation to elucidate mechanisms and applications.

Evaluation of choroidal parameters in eyes at the first onset of acute anterior uveitis

BACKGROUND

Little is known about choroidal involvement in anterior uveitis. The aim of our study was to evaluate changes in choroidal thickness and volume in eyes with acute anterior uveitis (AAU) using enhanced depth imaging-optical coherence tomography (EDI-OCT) at baseline and after treatment, which were compared with healthy fellow eyes.

METHODS

For the study, 35 individuals with unilateral acute AAU at the first onset were enrolled. Subfoveal thickness and choroidal volume were measured with EDI-OCT in nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields before and after the completion of treatment. Moreover, axial length measurements of both eye bulbs were determined by optical biometry.

RESULTS

No statistically significant differences in choroidal thickness or choroidal volume were detected between AAU eyes at baseline and after treatment and fellow eyes. Positive correlations between the values of anterior chamber flare and absolute CT changes in both temporal and inferior ETDRS fields, as well as in superior outer ring were detected. Negative correlations between age and both choroidal thickness and choroidal volume were detected in AAU eyes at baseline and after treatment, as well as in fellow eyes.

CONCLUSIONS

Evaluation of the choroid with EDI-OCT does not appear to be a reliable tool for the treatment monitoring of eyes with anterior uveitis.

Spectral domain optical coherence tomography as an adjunctive tool for screening Behçet uveitis

Background

This study investigated the association of central macular thickness (CMT) and macular volume (MV) with severity of Behçet uveitis in the absence of macular edema (ME).

Methods

This retrospective, interventional study included a total 131 treatment-naïve Behçet patients with varying degree of uveitis in the absence of ME. The mean CMT and MV were obtained by spectral domain optical coherence tomography (SD ODT). The patients were classified according to the anatomical classification of Behçet uveitis. The main outcome measure was comparison of mean CMT and MV with the types of Behçet uveitis.

Results

Sixty patients (45.8%) with no uveitis, 41 patients (31.3%) with anterior uveitis, 18 patients (13.7%) with posterior uveitis, and 12 patients (9.2%) with panuveitis. The mean CMT were 261.6±22.2 μm in no uveitis, 268.1±17.8 μm in anterior uveitis, 306.4±32.9 μm in posterior uveitis, and 300.4±44.0 μm in panuveitis (P < 0.001). The mean MV was 8.7±0.3 mm³ in those without uveitis, 8.8±0.3 mm³ in anterior uveitis, 9.9±1.1 mm³ in those with posterior uveitis, and 9.7±0.4 mm³ in panuveitis (P < 0.001). Types of Behçet uveitis was the only significant factor correlated with the mean CMT (B = 18.170, β = 0.408, P < 0.001) and the mean MV (B = 0.328, β = 0.652, P < 0.001).

Conclusions

The mean CMT and MV were significantly thicker in the Behçet uveitis with posterior involvement. SD OCT can be used for an adjunctive tool for screening Behçet uveitis, especially for the presence of posterior involvement.

Changes of Subfoveal Choroidal Thickness after Cataract Surgery: A Meta-Analysis

Purpose

To investigate the effect of cataract surgery on subfoveal choroid thickness (SFCT) using enhanced-depth imaging optical coherence tomography (EDI-OCT).

Materials and Methods

Relevant publications were searched systematically through various databases from inception to March 2018. The unit of choroidal thickness measurements is micrometers. Studies comparing SFCT before and after cataract surgery were retrieved. All qualified articles were analyzed using RevMan 5.3.

Results

A total of 13 studies with 802 eyes from 646 patients were identified for inclusion. There was a significant increase of SFCT at 1 week (MD = 6.62, 95% CI: 1.20-12.05, P=0.02, I² = 0%), 1 month (MD = 8.30, 95% CI: 3.20-13.39, P=0.001, I² = 0%), and 3 months (MD = 8.28, 95% CI: 1.84-14.73, P=0.01, I² = 0%) after cataract surgery. In subgroup analysis, SFCT in Asians and patients without nonsteroidal anti-inflammatory drugs (NSAIDs) in postoperative medication was significantly thicker (P < 0.05). No statistically significant increase of SFCT was found in diabetic mellitus (DM) patients for 1 day (P=0.89), 1 week (P=0.59), 1 month (P=0.52), and 3 months (P=0.42) after cataract surgery.

Conclusions

This meta-analysis suggested that SFCT increased since 1 week after the cataract surgery and the increase lasted for at least 3 months. Asians and patients without NSAIDs in postoperative medication were more likely to have a thicker SFCT after cataract surgery, whereas DM patients were less likely to increase in SFCT.

Repeatability of Arterial Spin Labeling MRI in Measuring Blood Perfusion in the Human Eye

BACKGROUND

Quantifying blood perfusion in ocular tissues is challenging, partly because the majority of the blood is carried by the choroid, which is difficult to visualize because it is located between the retina and sclera.

PURPOSE/HYPOTHESIS

To evaluate the intra- and interday repeatability of MRI measures of chorio-retinal blood perfusion.

STUDY TYPE

Prospective, cross-sectional, observational study.

POPULATION

Twenty young healthy adults (six male, age: 25 ± 5 years) scanned twice within a single session repeated at the same time of day on 2 days.

FIELD STRENGTH/SEQUENCE

Arterial spin labeling (ASL) MRI at 3.0T using pseudocontinuous ASL (PCASL) labeling scheme and a 3D turbo-gradient-spin-echo (TGSE) acquisition, including axial T₂ -weighted structural images using a 2D turbo-spin-echo (TSE) sequence.

ASSESSMENTS

Region-of-interest analysis for assessment of chorio-retinal blood perfusion.

STATISTICAL TESTS

Intra- and interday repeatability of measures analyzed using intraclass correlation coefficients (ICC), Pearson's correlation analysis, paired t-tests, and Bland-Altman plots.

RESULTS

The mean chorio-retinal perfusion was 77.86 (standard deviation [SD] = 29.80) ml/100ml/min. Perfusion measurements correlated strongly within a single session (r = 0.95, 95% confidence interval [CI] [0.880-0.980], P < 0.001) and between the two sessions based on a single run (r = 0.80 [0.582-0.913], P < 0.001), and two runs (r = 0.80 [0.479-0.918], P < 0.001). There were mean differences of 2.69 [16.85 to -22.23] ml/100ml/min for intraday measures, -7.44 [27.45 to -42.32] ml/100ml/min for single-run interday measures, and 5.73 [28.71 to -40.17] ml/100ml/min for two-run interday measures, but none were significant (all P > 0.05).

DATA CONCLUSION

Quantitative ASL-MRI measurements of chorio-retinal blood perfusion showed high intra- and interday repeatability. The ASL-MRI technique provides reliable measures of chorio-retinal perfusion in vivo.

LEVEL OF EVIDENCE

1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:966-974.

Analysis of choroidal and central foveal thicknesses in acute anterior uveitis by enhanced-depth imaging optical coherence tomography

Background

Currently, there are a limited number of reports of structural changes in the retina and choroid in acute anterior uveitis (AAU). The aim of this study was to evaluate choroidal and central foveal thicknesses during episodes of AAU.

Methods

The medical records of 120 patients with AAU and 120 healthy subjects matched for age, sex, and spherical equivalent of refractive error were reviewed. Subjects were divided into group 1 (AAU-affected eyes), 2 (unaffected fellow eyes), and 3 (healthy control eyes).

Results

In the uveitis group, etiologic diagnoses included human leukocyte antigen (HLA)-B27-associated (n = 71) and idiopathic (n = 49) AAU. The mean subfoveal choroidal thicknesses (SFCTs) in groups 1–3 were 326.7 ± 64.2, 296.1 ± 66.6, and 294.9 ± 41.7 μm, respectively. The corresponding mean central foveal thicknesses (CFTs) were 273.5 ± 29.3, 264.4 ± 24.6, and 263.0 ± 30.8 μm, respectively. The AAU group exhibited a significantly greater SFCT than the control groups (P < .001). Relative to the control group, while eyes with idiopathic AAU exhibited a significantly greater CFT, those with HLA-B27-associated AAU exhibited no such significant difference. Anterior chamber cell grade was not associated with SFCT or CFT.

Conclusions

The SFCT increased significantly during AAU. This indicates the importance of OCT examination for detection of subclinical choroidal and retinal changes in all types of AAU.

Choroidal change in acute anterior uveitis associated with human leukocyte antigen-B27

Purpose

To evaluate choroidal changes in eyes with acute anterior uveitis associated with human leukocyte antigen (HLA)-B27

Methods

In 44 patients with first-onset, unilateral, acute-onset (<1 week) anterior uveitis for which diagnostic work-ups revealed positivity only for HLA-B27, wide-field three-dimensional volumetric raster scan using swept-source optical coherence tomography was performed for both eyes. Choroidal thickness was measured by automated segmentation and thickness mapping and compared between eyes with uveitis and the fellow eyes at baseline. Choroidal thickness was compared before and after topical and/or systemic corticosteroid therapy. Relative choroidal thickening was defined as the choroidal thickness of the uveitic eye minus that of the corresponding eye and correlated with the degree of intraocular inflammation.

Results

Compared to the fellow eyes, eyes with acute anterior uveitis showed significant choroidal thickening on the subfoveal and parafoveal areas at baseline (all P <0.05). En face choroidal imaging showed dilation of large choroidal vessels on the macula. Relative choroidal thickening significantly correlated with the degree of anterior chamber inflammation at baseline (correlation coefficient = 0.341, P = 0.023). After treating inflammation, the choroid on the macula thinned significantly (from 262.1 ± 66.5 to 239.5 ± 61.0 μm in the subfoveal choroid, P<0.001).

Conclusions

Eyes with HLA-B27-associated anterior uveitis showed significant choroidal thickening at acute phase that subsequently decreased after treatment, indicating subclinical choroidal inflammation in the eyes. Choroidal thickness might indicate disease activity in acute anterior uveitis associated with HLA-B27.

Correlation of choroidal thickness and ametropiain young adolescence

Choroid has been proposed to participate in the regulation of light refraction by changing its thickness. The present study aims to analyze the characteristics of choroidal thickness (CT), and its correlation with refractive error, axial length and age in young ametropia. A total of 51 subjects (102 eyes), aged from 5 to 18 years old (mean age 10.04 ±2.78 years), with ametropia were included in the study. Choroidal imaging was obtained by enhanced depth imaging (EDI) of spectral domain Optical Coherence Tomography (OCT). CT was horizontally measured at 5 locations in across fovea with 1mm interval. We found that the spherical equivalent refractive diopter was from -7.25D to 1.6D (mean, -1.61D±1.82D), the mean axial length was 24.14mm±1.14mm. The closer to the optic disc the thinner the choroid is. CT between fovea and disc showed better correlation with refractive error (p< 0,01), axial length (p<0.01) and age (P<0.05) than those temporal to fovea. Our results indicated that the choroid is least thick around the optic disc. Thickness between fovea and optic disc is significantly associated with refractive error, axial length and age in growing adolescences. This result may help us understand the function of choroid during ametropic progression.

Recent advances in managing and understanding uveitis

Uveitis is a sight-threatening disease entity with intraocular inflammation that arises from various causes. It mainly affects working-age individuals and may lead to irreversible visual loss if not treated properly in a timely manner. This article reviews recent advances in the management and understanding of uveitis since 2014, including treatment with new immunosuppressive therapies that use biological agents, local therapy with steroid implants, and imaging studies for the evaluation of uveitis.

Choroidal thickness changes determined by EDI-OCT on acute anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis

PURPOSE

To evaluate the choroidal thickness on acute anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis.

METHODS

In this study, 32 eyes of 16 HLA-B27 positive AS patients with anterior uveitis and age-matched 19 eyes for control group were analyzed between January 2014 and April 2015. Assessment criteria were uveitis activity, visual acuity, flare existence, subfoveal choroidal thickness and central macular thickness measurements.

RESULTS

The mean subfoveal choroidal thicknesses in affected eye group (Group 1), unaffected eye group (Group 2) and control group (Group 3) were 348.31 ± 72.7, 301.12 ± 49.2 and 318.0 ± 74.3, respectively, in active periods. (p = 0.04 between Group 1 and Group 2, p = 0.234 between Group 1 and Group 3) The mean central macular thicknesses of Group 1, Group 2 and Group 3 were 268.50 ± 16.5, 267.31 ± 16.3 and 249.7 ± 30.5, respectively, in active periods. (p = 0.84 between Group 1 and Group 2, p = 0.029 between Group 1 and Group 3). However, in convalescence period, the mean subfoveal choroidal thicknesses of Group 1, Group 2 and Group 3 were 322.40 ± 48.5, 300.75 ± 47.7 and 318.0 ± 74.3, respectively. (p = 0.22 between Group 1 and Group 2, p = 0.854 between Group 1 and Group 3) The mean central macular thicknesses of Group 1, Group 2 and Group 3 were 269.75 ± 21.9, 256.62 ± 21.5 and 249.7 ± 30.5, respectively. (p = 0.09 between Group 1 and Group 2, p = 0.03 between Group 1 and Group 3).

CONCLUSIONS

In HLA-B27 positive ankylosing spondylitis patients with anterior uveitis, the choroidal thicknesses of the affected eyes were found as thicker than fellow unaffected one or control eyes in active period. The central macular thicknesses are not affected on both active and convalescent period.

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.

Choroidal Vascularity Index (CVI)--A Novel Optical Coherence Tomography Parameter for Monitoring Patients with Panuveitis?

PURPOSE

To compute choroidal vascularity index (CVI) using an image binarization tool on enhanced depth imaging (EDI)-optical coherence tomography (OCT) scans as a non-invasive optical tool to monitor progression in panuveitis and to investigate the utility of volumetric data from EDI-OCT scans using custom image analysis software.

MATERIALS AND METHODS

In this retrospective cohort study, segmented EDI-OCT scans of both eyes in 19 patients with panuveitis were taken at baseline and at 3-month follow-up and were compared with EDI-OCT scans of normal eyes. Subfoveal choroidal area was segmented into luminal (LA) and stromal interstitial area (SA). Choroidal vascularity index (CVI) was defined as the proportion of LA to the total circumscribed subfoveal choroidal area (TCA).

RESULTS

The mean choroidal thickness was 265.5±100.1μm at baseline and 278.4±102.6μm at 3 months follow up (p = 0.06). There was no statistically significant difference in TCA between study and control eyes (p = 0.08). CVI in the control group was 66.9±1.5% at baseline and 66.4±1.5% at follow up. CVI was 74.1±4.7% at baseline and 69.4±4.8% at 3 months follow up for uveitic eyes (p<0.001). The % change in CVI was 6.2 ±3.8 (4.3 to 8.0) for uveitic eyes, which was significantly higher from % change in CVI for control eyes (0.7±1.1, 0.2 to 1.3, p<0.001).

CONCLUSION

The study reports composite OCT-derived parameters and CVI as a possible novel tool in monitoring progression in panuveitis. CVI may be further validated in larger studies as a novel optical tool to quantify choroidal vascular status.

Retinal and Choroidal Thickness in Patients with Uveitis

PURPOSE

To study retinal thickness (RT) and choroidal thickness (CT) in patients with inactive uveitis. We also investigated the correlation between RT and CT and the duration and frequency of inflammation and visual acuity in patients with inactive uveitis.

METHODS

One-hundred and forty-eight eyes from 97 patients (mean age 51.0 ± 15.7 years) and 98 eyes from 55 normal subjects (mean age 59.3 ± 14.4 years) were studied. Routine ophthalmic examination included spectral-domain optical coherence tomography with enhanced depth imaging of the retina and choroid. CT was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 500-µm intervals of the horizontal section between 2.5 mm temporal and 2.5 mm nasal to the fovea. RT was measured between the inner limiting membrane and the retinal pigment epithelium.

RESULTS

Mean subfoveal RT did not differ significantly between uveitis patients and controls. Mean CT at multiple locations was significantly lower in patients with uveitis compared to normal subjects; this difference was most significant at the fovea (uveitis group, 229 ± 85 µm vs. control group, 276 ± 74 µm; p < 0.001). Only CT was associated with duration and frequency of inflammation in patients with anterior uveitis (r = -0.298, p = 0.008; r = -0.349, p = 0.002, respectively).

CONCLUSION

CT is reduced in patients with inactive uveitis and is associated with disease duration and frequency whereas RT does not seem to be affected by disease processes.