Why Is Imaging Critical in My Uveitis Practice? Dilraj S. Grewal, MD Developed in collaboration Imaging Is the Backbone of Uveitis Workup and Monitoring Treatment Response FP FAF B- scan Multimodal Imaging ICGA FA (WF) OCT OCTA Abbreviations: FP = fundus photography OCT = optical coherence tomography OCTA = optical coherence tomography angiography FA (WF) = fluorescein angiography (wide field) ICGA = indocyanine green angiography B-scan = B-scan ultrasound FAF = fundus autofluorescence Pichi F, et al. Prog Retin Eye Res. 2017;59:178-201; Denniston AK, et al. Invest Ophthalmol Vis Sci. 2017;58:BIO131-40; Gangaputra S, et al. Ocul Immunol Inflamm. 2017;25:160-8. 1
Young Woman With Decreased Vision OU x 1 Week External Examination: Malar Butterfly Rash Case 1 20/60 20/80 Agarwal A, et al. Clin Exp Ophthalmol. 2018;46:62-74. FA Is Critical to Assess Severity of Retinal Vasculitis Retinal vasculitis in macula is urgently vision threatening Tolba DA, et al. Ocul Immunol Inflamm. 2017;25:884-90; Lee JH, et al. Clin Exp Rheumatol. 2013;31:871-6. 2
OCT Possible OCT markers as VA surrogates: External limiting membrane integrity Ellipsoid zone integrity Hyperreflective foci Subretinal fluid Pattern of cystoid macular edema (cystoid > diffuse) Disorganization of retinal inner layers Hyperreflective Foci Subretinal Fluid Grewal DS, et al. Am J Ophthalmol. 2017;177:116-25; Pelosini L, et al. Invest Ophthalmol Vis Sci. 2011;52:2741-8; Sugar EA, et al. Am J Ophthalmol. 2011;152:1044-52.e5. After Treatment for 6 Months With Cyclophosphamide No DRIL 20/20 OU Few residual HRF External exam: resolution of malar/periocular rash Micro NFL infarcts can cause NFL loss and VF defects Shulman S. Lupus. 2017;26:1420-5. 3
OCT Biomarkers EDI OCT: Monitoring Changes in Choroidal Thickness Punctate Inner Choroiditis Reduction in Choroidal Thickness After Initiation of Therapy Agrawal R, et al. Int Ophthalmol. 2018;38:993-1002. Vogt-Koyanagi-Harada Disease: Monitor Choroidal Thickness on EDI OCT 20/100 20/30 20/20 Jap A, et al. Br J Ophthalmol. 2017;101:186-9; da Silva FT, et al. Br J Ophthalmol. 2013;97:70-4. 4
Pediatric Patient With Floaters and Decreased Vision OD Case 2 20/200 20/20 Intermediate Uveitis With Perivascular Leakage Improvement in disc and perivascular leakage with treatment Can obtain oral fluorescein in children Patel M, et al. Curr Opin Ophthalmol. 2014;25:213-20; Tsui I, et al. Ophthalmic Surg Lasers Imaging Retina. 2013;44:59-67. 5
OCT to Visualize Vitreous Cells Keane PA, et al. Ophthalmology. 2014;121:1706-14. 20/20 Middle-Aged Man With Shadow in Vision OD x 3 Months 20/40 20/20 Case 3 6
FAF TB-Associated Serpiginous-Like Choroiditis 6 months post-treatment with INH and rifampin and 6-week course of tapering steroids Case 3 20/40 20/30 Treatment response with reduction of hyperautofluorescence Using ICGA Immunosuppressed Man With Cryptococcal Choroiditis Case 4 Reprinted with permission. Vu DM, et al. Retin Cases Brief Rep. 2018. doi: 10.1097/ICB.0000000000000703. Accessed October 29, 2018 [Epub ahead of print] 7
Immunosuppressed Man With Cryptococcal Choroiditis OCTA shows choriocapillaris flow voids, which colocalize with areas of hypocyanescence on ICG OCTA-ICG Overlay OCTA-ICG Colocalization Reprinted with permission. Vu DM, et al. Retin Cases Brief Rep. 2018. doi: 10.1097/ICB.0000000000000703. Accessed October 29, 2018 [Epub ahead of print] OCTA: Inflammatory CNV RETCAM FA High flow lesion OCTA Agarwal A, et al. J Ophthalmic Inflamm Infect. 2018;8:13. OCT and OCTA to monitor response to anti-vegf treatment 8
Serpiginous Choroiditis: OCTA Shows Nonperfusion in Choriocapillaris Flow voids Photo FAF OCTA Choriocapillaris Slab Borrelli E, et al. Prog Retin Eye Res. 2018. [Epub ahead of print]; El Ameen A, et al. Retin Cases Brief Rep. 2018;12:279-85. OCTA in Retinal Vasculitis Churg-Strauss Syndrome Spaide RF. Retina. 2017;37:1034-42. 9
2018 Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors. 10
Imaging in Uveitis: Abbreviations and Acronyms B-scan = B-scan ultrasound CME = cystoid macular edema CNV = choroidal neovascularization DRIL = disorganization of retinal inner layers EDI = enhanced depth imaging FA = fluorescein angiography FAF = fundus autofluorescence FP = fundus photography HRF = hyperreflective foci ICGA = indocyanine green angiography INH = isoniazid NFL = nerve fiber layer OCT = optical coherence tomography OCTA = optical coherence tomography angiography OD = oculus dexter (right eye) OS = oculus sinister (left eye) OU = oculus uterque (both eyes) TB = tuberculosis VA = visual acuity VEGF = vascular endothelial growth factor VF = visual field WF = wide field