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Mauschitz MM, Zeller M, Sagar P, Biswal S, Guzman G, Terheyden JH, Meyer CH, Holz FG, Heinz C, Pleyer U, Finger RP, Wintergerst MWM. Fundus Autofluorescence in Posterior and Panuveitis-An Under-Estimated Imaging Technique: A Review and Case Series. Biomolecules 2024; 14:515. [PMID: 38785922 PMCID: PMC11118036 DOI: 10.3390/biom14050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 05/25/2024] Open
Abstract
Fundus autofluorescence (FAF) is a prompt and non-invasive imaging modality helpful in detecting pathological abnormalities within the retina and the choroid. This narrative review and case series provides an overview on the current application of FAF in posterior and panuveitis. The literature was reviewed for articles on lesion characteristics on FAF of specific posterior and panuveitis entities as well as benefits and limitations of FAF for diagnosing and monitoring disease. FAF characteristics are described for non-infectious and infectious uveitis forms as well as masquerade syndromes. Dependent on the uveitis entity, FAF is of diagnostic value in detecting disease and following the clinical course. Currently available FAF modalities which differ in excitation wavelengths can provide different pathological insights depending on disease entity and activity. Further studies on the comparison of FAF modalities and their individual value for uveitis diagnosis and monitoring are warranted.
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Affiliation(s)
- Matthias M. Mauschitz
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Markus Zeller
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Pradeep Sagar
- Sankara Academy of Vision, Sankara Eye Hospital Shimoga, Shimoga 577202, India; (P.S.)
| | - Suchitra Biswal
- Sankara Academy of Vision, Sankara Eye Hospital Shimoga, Shimoga 577202, India; (P.S.)
| | - Gabriela Guzman
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Jan H. Terheyden
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Carsten H. Meyer
- Augenzentrum Grischun, 7000 Chur, Switzerland
- Department of Ophthalmology, Philipps University, 35037 Marburg, Germany
| | - Frank G. Holz
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus-Hospital Muenster, 48145 Muenster, Germany;
- Department of Ophthalmology, University Duisburg-Essen, 45122 Essen, Germany
| | - Uwe Pleyer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
- Department of Ophthalmology, Berlin and Berlin Institute of Health, 13353 Berlin, Germany
| | - Robert P. Finger
- Department of Ophthalmology, University Medical Center Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Maximilian W. M. Wintergerst
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
- Augenzentrum Grischun, 7000 Chur, Switzerland
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Azzopardi M, Chong YJ, Sreekantam S, Barry RJ, Poonit N, Rauz S, Murray PI. Real-World Experience in the Use of Immunosuppression for the Management of Inflammatory Eye Disease. Ocul Immunol Inflamm 2024:1-10. [PMID: 38349962 DOI: 10.1080/09273948.2024.2311743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE Patients with sight-threatening inflammatory eye disease (IED) are maintained on systemic immunosuppression whilst in long-term clinical remission. There are no clear guidelines on the duration of remission before implementing treatment withdrawal. We present a real-world analysis on the use of immunosuppression in IED in long-term remission and consider strategies for withdrawal. METHODS Adult IED patients on systemic immunosuppression were categorised into four disease groups: Corneal Transplant Survival Strategies (CTSS), Ocular Surface Disease (OSD), Non-infectious Uveitis (NIU) and Scleritis. Patients with Behçet's disease were excluded. Data on systemic immunosuppressants and biologics used; duration of treatment; reasons for drug discontinuation; disease activity/remission status; duration of clinical remission with an emphasis on patients who had been in remission for a minimum of 24 months were captured. RESULTS Out of a total of 303 IED patients, 128 were on systemic immunosuppression with a clinical remission of their ocular disease for ≥24 months. The median duration of remission was 4-5 years with the longest duration of remission 22 years, and some patients on immunosuppression for up to 23 years. Sixty patients stopped at least one immunosuppressive agent without prior discussion with a health-care practitioner. CONCLUSION Progressive conditions, such as cicatrising conjunctivitis may require lifelong immunosuppression, but patients with NIU and Scleritis and those on CTSS, immunosuppression withdrawal should be considered if they remain in remission for 2 years. Any patient stopping a medication should be contacted immediately for counselling. These data will better inform patients, encourage adherence and aide formal guideline development.
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Affiliation(s)
- Matthew Azzopardi
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Yu Jeat Chong
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Sreekanth Sreekantam
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Robert J Barry
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Natraj Poonit
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Philip I Murray
- Centre for Inflammatory Eye Disease, Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Wintergerst MWM, Merten NR, Berger M, Terheyden JH, Overbeck LJ, Schmid M, Holz FG, Finger RP. Vessel density on optical coherence tomography angiography is prognostic for future disease course in intermediate uveitis. Sci Rep 2024; 14:2933. [PMID: 38317017 PMCID: PMC10844199 DOI: 10.1038/s41598-023-49926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024] Open
Abstract
As most rare diseases, intermediate uveitis lacks reliable endpoints necessary for randomized clinical trials. Therefore, we investigated longitudinal changes of retinal and choriocapillaris perfusion on optical coherence tomography angiography (OCT-A) in intermediate uveitis and their prognostic value for future best corrected visual acuity (BCVA) and central retinal thickness (CRT). In this retrospective, longitudinal cohort study eyes of patients with intermediate uveitis were imaged by swept-source OCT-A (macula-centered 3 × 3 mm; PLEX Elite 9000, Zeiss) and stratified into clinically stable, worsened and improved based on changes in clinical parameters. Superficial (SRL) and deep retinal layers (DRL) were automatically analyzed for vessel density (VD) and choriocapillaris layer for non-perfused area (CCNPA) using ImageJ. Mixed-effects regression analysis controlling for age, sex, and OCT-A signal strength index (SSI) was used to evaluate the prognostic value of OCT-A parameters. 91 eyes (62 stable, 12 worsened, and 17 improved) were included in the analysis and mean follow-up time was 296 days. Longitudinal changes of VD were different between all three groups (p = 0.002 for SRL and p = 0.017 for DRL). Clinically worsened eyes showed a decrease in VD (- 0.032 ± 0.055 for SRL and - 0.027 ± 0.025 for DRL), whereas clinically improved eyes showed an increase in VD (0.037 ± 0.039 for SRL and 0.001 ± 0.023 for DRL). No difference was found for CCNPA. When controlling for age, sex, and SSI, observed differences held true in clinically worsened eyes for DRL (p = 0.011) and in clinically improved eyes for SRL (p = 0.002). An increase of CCNPA in clinically worsened eyes (p = 0.03) compared to clinically stable and improved eyes was evident. Predictive analysis revealed an association of VD in SRL and DRL at baseline with BCVA at follow-up (p = 0.039 and p = 0.047, respectively) and of VD in SRL at baseline with CRT at follow-up (p = 0.046). Alterations in retinal perfusion on OCT-A in intermediate uveitis are partly reversible and OCT-A VD may serve to predict future BCVA and CRT. Thus, perfusion parameters on OCT-A might aid monitoring and serve as prognostic imaging-biomarker.
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Affiliation(s)
- Maximilian W M Wintergerst
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Ernst-Abbe-Straße 2, 53127, Bonn, Germany.
- Augenzentrum Grischun, KammannEye AG, Chur, Switzerland.
| | - Nicholas R Merten
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Moritz Berger
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Lennart J Overbeck
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
- Department of Ophthalmology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Spectrally resolved autofluorescence imaging in posterior uveitis. Sci Rep 2022; 12:14337. [PMID: 36038591 PMCID: PMC9424200 DOI: 10.1038/s41598-022-18048-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
Clinical discrimination of posterior uveitis entities remains a challenge. This exploratory, cross-sectional study investigated the green (GEFC) and red emission fluorescent components (REFC) of retinal and choroidal lesions in posterior uveitis to facilitate discrimination of the different entities. Eyes were imaged by color fundus photography, spectrally resolved fundus autofluorescence (Color-FAF) and optical coherence tomography. Retinal/choroidal lesions’ intensities of GEFC (500–560 nm) and REFC (560–700 nm) were determined, and intensity-normalized Color-FAF images were compared for birdshot chorioretinopathy, ocular sarcoidosis, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), and punctate inner choroidopathy (PIC). Multivariable regression analyses were performed to reveal possible confounders. 76 eyes of 45 patients were included with a total of 845 lesions. Mean GEFC/REFC ratios were 0.82 ± 0.10, 0.92 ± 0.11, 0.86 ± 0.10, and 1.09 ± 0.19 for birdshot chorioretinopathy, sarcoidosis, APMPPE, and PIC lesions, respectively, and were significantly different in repeated measures ANOVA (p < 0.0001). Non-pigmented retinal/choroidal lesions, macular neovascularizations, and fundus areas of choroidal thinning featured predominantly GEFC, and pigmented retinal lesions predominantly REFC. Color-FAF imaging revealed involvement of both, short- and long-wavelength emission fluorophores in posterior uveitis. The GEFC/REFC ratio of retinal and choroidal lesions was significantly different between distinct subgroups. Hence, this novel imaging biomarker could aid diagnosis and differentiation of posterior uveitis entities.
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Chen X, Zhu W, Li X. OCT Macular Volume as a Predictor of Vascular Leakage in Uveitis. Ophthalmol Ther 2022; 11:1913-1924. [PMID: 35978263 PMCID: PMC9437176 DOI: 10.1007/s40123-022-00558-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction This study aimed to evaluate the optical coherence tomography (OCT) macular volume as a marker for active vascular leakage in patients with intermediate and pan uveitis. Methods In this single-center prospective longitudinal study, patients were included under three criteria: diagnosed with noninfectious intermediate or pan uveitis; presented vascular leakage at their initial visit; and were imaged with concurrent wide-field fluorescein angiography (FA) and OCT. A scoring system was employed to measure vascular leakage. OCT volume scans were performed on the patients to produce the corresponding thickness map. The central subfield thickness (CST) and macular volume (MV) were calculated. CST is defined as the average thickness within the 1-mm fovea circle, while MV includes the 3-mm and 6-mm circles on the thickness map. Mixed-effects models were applied to analyze the correlation between each patient’s OCT and FA imaging results. Results A total of 72 patients (115 eyes) were included. The median follow-up time was 11 months (interquartile range 1.8–16.1 months). A total of 679 observations across all time points were analyzed. Both CST and MV were found to be positively associated with the leakage scores (p < 0.001). In the mixed-effects models, MV in the 6-mm circle presented the strongest correlation with leakage scores, which explained 57% of the variation in leakage (p < 0.001). MV in the 3-mm circle and CST explained 45.8% and 39.5%, respectively. Conclusion CST and MV in both the 6-mm and the 3-mm circles demonstrated significant correlations with angiographic inflammatory activity. Among those imaging parameters, MV in the 6-mm circle has the highest correlation. The study results suggest that this parameter can be considered a quantitative and non-invasive alternative to FA for monitoring vasculitic inflammation in uveitis. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00558-z.
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Affiliation(s)
- Xiuju Chen
- Xiamen Eye Center of Xiamen University, No. 989 Wutong West Road, Xiamen, 361000, Fujian, China
| | - Wenyue Zhu
- University of Liverpool, 6 West Derby Street, Liverpool, UK
| | - Xiaoxin Li
- Xiamen Eye Center of Xiamen University, No. 989 Wutong West Road, Xiamen, 361000, Fujian, China. .,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Xiamen University, Xiamen, China.
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6
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Kale AU, Serrano A, Liu X, Balasubramaniam B, Keane PA, Moore DJ, Llorenç V, Denniston AK. Measuring Inflammation in the Vitreous and Retina: A Narrative Review. Ocul Immunol Inflamm 2022; 31:768-777. [PMID: 35412855 DOI: 10.1080/09273948.2022.2049316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Uveitis consists of a group of syndromes characterised by intraocular inflammation, accounting for up to 15% of visual loss in the western world and 10% worldwide. Assessment of intraocular inflammation has been limited to clinician-dependent, subjective grading. Developments in imaging technology, such as optical coherence tomography (OCT), have enabled the development of objective, quantitative measures of inflammatory activity. Important quantitative metrics including central macular thickness and vitreous signal intensity allow longitudinal monitoring of disease activity and can be used in conjunction with other imaging modalities enabling holistic assessment of ocular inflammation. Ongoing work into the validation of instrument-based measures alongside development of core outcome sets is crucial for standardisation of clinical trial endpoints and developing guidance for quantitative multi-modal imaging approaches. This review outlines methods of grading inflammation in the vitreous and retina, with a focus on the use of OCT as an objective measure of disease activity.
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Affiliation(s)
- Aditya U Kale
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alba Serrano
- Ocular Infection & Inflammation, Clínic Institute of Ophthalmology Clínic Hospital of Barcelona, Barcelona, Spain
| | - Xiaoxuan Liu
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
| | - Balini Balasubramaniam
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Victor Llorenç
- Ocular Infection & Inflammation, Clínic Institute of Ophthalmology Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer, Clínic Hospital of Barcelona, Barcelona, Spain
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Pohlmann D, Rademacher J, Pleyer U. HLA-B27 assoziierte anteriore Uveitis: Herausforderung für
eine interdisziplinäre Zusammenarbeit. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1662-4086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungDie akute anteriore Uveitis (AAU) ist die häufigste Form intraokularer
Entzündungen, die v. a. Personen im erwerbsfähigen Alter
betrifft und mit erheblichen sozioökonomischen Auswirkungen verbunden
ist. Etwa die Hälfte der AAU-Patienten sind HLA-B27 positiv und teilen
ein hohes Risiko zu HLA-B27-assoziierten Erkrankungen, insbesondere zur
Spondyloarthritis (SpA). Sowohl die SpA als auch die AAU sind komplexe
entzündliche Erkrankungen, deren genaue Pathogenese unbekannt ist. Da
bei bis zu 40% der AAU-Patienten eine nicht diagnostizierte SpA
vorliegt, bietet die AAU die Möglichkeit einer frühzeitigen
Erkennung der zugrundeliegenden rheumatologischen Erkrankung. Die klinische
Präsentation der AAU bei SpA weist eine Reihe typischer Augenbefunde
auf, die diagnostisch wegweisend sind und auf eine systemische Grunderkrankung
hindeuten können. Daher ist eine abgestimmte
Überweisungsstrategie zur zügigen Diagnostik und Behandlung
notwendig. Dieser Beitrag fokussiert daher auf die interdisziplinäre
Zusammenarbeit und bietet gleichzeitig Hinweise für die
differentialdiagnostische Abklärung.
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Affiliation(s)
- Dominika Pohlmann
- Universitäts-Augenklinik, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt-Universität zu Berlin, and Berlin
Institute of Health, Department of Ophthalmology, Berlin, Germany
| | - Judith Rademacher
- Universitäts-Augenklinik, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt-Universität zu Berlin, and Berlin
Institute of Health, Division of Gastroenterology, Infectious Diseases and
Rheumatology, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health at Charité –
Universitätsmedizin Berlin, Berlin, Germany
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