Quantitative Analysis of Peripheral Vasculitis, Ischemia, and Vascular Leakage in Uveitis Using Ultra-Widefield Fluorescein Angiography

• Published in: American journal of ophthalmology Vol. 159; no. 6; pp. 1161 - 1168.e1
• Main Authors: Karampelas, Michael, Sim, Dawn A., Chu, Colin, Carreno, Ester, Keane, Pearse A., Zarranz-Ventura, Javier, Westcott, Mark, Lee, Richard W.J., Pavesio, Carlos E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Blood-Retinal Barrier; Capillary Permeability; Cross-Sectional Studies; Data collection; Diabetic retinopathy; Female; Fluorescein Angiography - methods; Glucocorticoids - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Ischemia; Ischemia - diagnosis; Ischemia - physiopathology; Macular degeneration; Male; Medical imaging; Middle Aged; Ophthalmology; Retinal Neovascularization - diagnosis; Retinal Neovascularization - physiopathology; Retinal Vasculitis - diagnosis; Retinal Vasculitis - physiopathology; Retinal Vessels - pathology; Uveitis - diagnosis; Uveitis - drug therapy; Uveitis - physiopathology; Young Adult; United Kingdom > UK; Scotland; California
• DOI: 10.1016/j.ajo.2015.02.009
• ISSN: 0002-9394; 1879-1891

To investigate the relationships between peripheral vasculitis, ischemia, and vascular leakage in uveitis using ultra-widefield fluorescein angiography (FA). Cross-sectional, consecutive case series. Consecutive ultra-widefield FA images were collected from 82 uveitis patients (82 eyes) in a single center. The extent of peripheral vasculitis, capillary nonperfusion, and vessel leakage were quantified. Parameters included: (1) foveal avascular zone area and macular leakage, (2) peripheral diffuse capillary leakage and ischemia, (3) peripheral vasculitis, and (4) leakage from neovascularization. Central macular thickness measurements were derived with optical coherence tomography. Main outcome measures were correlations between central and peripheral fluorangiographic changes as well as associations between visual function, ultra-widefield FA–derived metrics, and central macular thickness. Although central leakage was associated with peripheral leakage (r = 0.553, P = .001), there was no association between foveal avascular zone size and peripheral ischemia (r = 0.114, P = .324), regardless of the underlying uveitic diagnosis. Peripheral ischemia was, however, correlated to neovascularization-related leakage (r = 0.462, P = .001) and focal vasculitis (r = 0.441, P = .001). Stepwise multiple regression analysis revealed that a poor visual acuity was independently associated with foveal avascular zone size and central macular thickness (R2-adjusted = 0.45, P = .001). We present a large cohort of patients with uveitis imaged with ultra-widefield FA and further describe novel methods for quantification of peripheral vascular pathology, in an attempt to identify visually significant parameters. Although we observed that relationships exist between peripheral vessel leakage, vasculitis, and ischemia, it was only macular ischemia and increased macular thickness that were independently associated with a reduced visual acuity.