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Use of optical coherence tomography angiography in the uveitis clinic. Graefes Arch Clin Exp Ophthalmol 2023; 261:23-36. [PMID: 35841398 DOI: 10.1007/s00417-022-05763-x] [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: 12/16/2021] [Revised: 06/04/2022] [Accepted: 07/09/2022] [Indexed: 01/04/2023] Open
Abstract
As optical coherence tomography angiography is revolutionizing the ophthalmology world, the uveitis community is learning to understand where and how this new powerful imaging tool fits into the management of the panorama of ocular inflammations and infections. A non-invasive method of studying the retinal and choroidal vasculature, OCTA allows for the assessment of vessel density changes during active and inactive uveitis making it the natural imaging application of choice in uveitis clinical trials. However, these data and results are of limited utility to the ophthalmologists who are looking to apply OCTA in their everyday uveitis clinic. If employed strategically, OCTA can be a powerful tool for the uveitis specialist to evaluate iris involvement in viral uveitis; to assess the integrity of the vascular layers in the settings of white dot syndromes; to distinguish inflammatory choroidal neovascularization from outer retinal avascular inflammatory material; and to diagnose and follow infectious choroidal granulomas and satellite foci of chorioretinal inflammation without the need to administer dyes. The present review will analyze all the recent publications that apply OCTA in uveitis to offer the reader a guide on how to maximize the utility of this imaging modality in a clinical practice.
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Luo M, Li Y, Zhuo Y. Advances and Current Clinical Applications of Anterior Segment Optical Coherence Tomography Angiography. Front Med (Lausanne) 2021; 8:721442. [PMID: 34888319 PMCID: PMC8649770 DOI: 10.3389/fmed.2021.721442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is the most relevant evolution based on optical coherence tomography (OCT). OCTA can present ocular vasculature, show detailed morphology for assessment, and quantify vessel parameters without intravenous dye agent. Research on the anterior segment OCTA (AS-OCTA) is only in its initial phase, and its advances in clinical diagnosis and treatment efficacy evaluations require a detailed comparison to traditional imaging methods. In this review of AS-OCTA, we summarize its technical features, imaging advances, current clinical applications in various eye diseases, as well as its limitations and potential future directions. AS-OCTA offers potential advantages in ophthalmic imaging, and with further development it could become a common tool in the near future.
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Affiliation(s)
- Man Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yiqing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Pichi F, Roberts P, Neri P. The broad spectrum of application of optical coherence tomography angiography to the anterior segment of the eye in inflammatory conditions: a review of the literature. J Ophthalmic Inflamm Infect 2019; 9:18. [PMID: 31485882 PMCID: PMC6726732 DOI: 10.1186/s12348-019-0184-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background With an increased number of papers on how to interpret optical coherence tomography angiography (OCTA) findings in uveitis, the aim of this review is to assess its efficacy for the quantitative monitoring of structural and functional changes in inflamed conjunctiva and iris vessels in patients with acute anterior uveitis and iris neovascularization. Main body OCTA, currently designed as a retinal vascular imaging system, has been recently adapted for anterior segment and showed good potential for successful imaging of the conjunctiva, the cornea, and the iris. OCTA can successfully delineate corneal vessels with substantial image quality. At the same time, it can detect changes in conjunctival and limbal vascularization and thus can be applied to pseudo-inflammatory conditions such as pterygium. Anterior segment OCTA allows analysis of iris vasculature and 3-D reconstruction of the normal iris vessels. OCTA can determined iris vessel filling defects or their flow increase, when present, secondary to inflammatory conditions. In addition, OCTA gives qualitative vessel density values that can be compared pre- and post-anti-inflammatory treatment. OCTA for imaging of the iris vasculature in health and disease is highly dependent on iris pigmentation. In both OCTA and fluorescein angiography, iris pigmentation causes vasculature imaging blockage, but OCTA provides more detailed iris vasculature images. Fine, clinically invisible iris vessels can be visualized by OCTA in the very early stages as well as in the regressed stage of NVI. Additional studies including different iris pathologies are needed to determine the most optimal scanning parameters in OCTA of the anterior segment. Conclusions This review aims to establish the current application of OCTA to anterior segment disorders of the eye, with an emphasis on exploring its use in iris vessel dilation seen in various forms of iritis, as a predictive factor for further episodes of inflammation. In addition, OCTA can depict neovascularization of the iris secondary to proliferative diabetic retinopathy.
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Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, UAE. .,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA.
| | - Philipp Roberts
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA
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Shields JA, Shields CL, Lally SE, Milman T, Eagle RC. Iris Melanoma in a Child Simulating Juvenile Xanthogranuloma. Middle East Afr J Ophthalmol 2018; 25:115-117. [PMID: 30122859 PMCID: PMC6071340 DOI: 10.4103/meajo.meajo_7_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
An 8-year-old girl was referred for an amelanotic iris tumor believed to have enlarged slightly over 3 months, suspicious for juvenile xanthogranuloma (JXG). The affected right eye had a lightly pigmented, vascular iris mass measuring 6 mm in basal dimension and 2 mm in thickness. There were no feeder vessels, seeding, inflammatory cells, or cutaneous abnormalities. Diagnostic fine needle aspiration biopsy (FNAB) was performed, revealing spindle B melanoma cells that were immunoreactive for melanocytic markers HMB45 and Melan-A. Complete tumor resection by basal sector iridectomy was performed. Histopathology confirmed spindle B melanoma. At 14-years follow up, there has been no recurrence or metastasis and visual acuity remains 20/25. Iris melanoma can develop in children and clinically resemble nodular JXG.
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Affiliation(s)
- Jerry A. Shields
- Department of Ocular Oncology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L. Shields
- Department of Ocular Oncology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sara E. Lally
- Department of Ocular Oncology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph C. Eagle
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Meyer P, Graeff E, Kohler C, Munier F, Bruder E. Juvenile xanthogranuloma involving concurrent iris and skin: Clinical, pathological and molecular pathological evaluations. Am J Ophthalmol Case Rep 2017; 9:10-13. [PMID: 29468209 PMCID: PMC5787822 DOI: 10.1016/j.ajoc.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/04/2017] [Accepted: 09/19/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose To report a case of juvenile xanthogranuloma involving the iris and skin that clincally was diagnosed with an obvious cutaneous lesion. Observations A four month-old girl with hyphema and increased intraocular pressure of the left eye persisting for 2 weeks. A suspicious yellow-brown mass with nodular surface and traversed by irregular vascularization was noted on the inferior iris surface. Ultrasound biomicroscopy (UBM; 35 MHz) of the mass revealed multiple nodular irregular hyperreflective lesions in the peripheral iris. Using a biopsy of an obvious cutaneous abdominal skin lesion a diagnosis was made based on histopathological analyses. The biopsy showed dense dermal infiltrate consisting of foamy histiocytes. Additional stains revealed CD68 positivity and CD1a and S100 negativity. This mass revealed histopathologic features identical to juvenile xanthogranuloma and was concurrent with the iris lesion. Next-generation sequencing using Ion AmpliSeqTM Cancer Hotspot Panel revealed a missense mutation of FGFR3 (p.F386L). Conclusion and importance The diagnosis of a xanthogranuloma of the iris with hyphema can be made easier in patients with obvious cutaneous lesions as described in our case. The significance of FGFR3 mutation in association with JXG is unknown and should be further investigated.
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Affiliation(s)
- Peter Meyer
- Department of Ophthalmology, University Basel, Mittlere Strasse 91, Basel CH-4031, Switzerland
| | - Elisabeth Graeff
- Department of Ophthalmology, University Basel, Mittlere Strasse 91, Basel CH-4031, Switzerland
| | - Corina Kohler
- Department of Ophthalmology, University Basel, Mittlere Strasse 91, Basel CH-4031, Switzerland
| | - Francis Munier
- Department of Ocular Oncology, Jules-Gonin Eye Hospital, 15 Av. de France, Lausanne CH-1004, Switzerland
| | - Elisabeth Bruder
- Department of Pathology, University Basel, Schönbeinstrasse 40, 4003 Basel, Switzerland
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Pichi F, Sarraf D, Arepalli S, Lowder CY, Cunningham ET, Neri P, Albini TA, Gupta V, Baynes K, Srivastava SK. The application of optical coherence tomography angiography in uveitis and inflammatory eye diseases. Prog Retin Eye Res 2017; 59:178-201. [DOI: 10.1016/j.preteyeres.2017.04.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 01/03/2023]
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Samara WA, Khoo CT, Say EAT, Saktanasate J, Eagle RC, Shields JA, Shields CL. Juvenile Xanthogranuloma Involving the Eye and Ocular Adnexa. Ophthalmology 2015; 122:2130-8. [DOI: 10.1016/j.ophtha.2015.06.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/02/2015] [Accepted: 06/05/2015] [Indexed: 11/15/2022] Open
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Samara WA, Khoo CTL, Magrath G, Shields CL. Multimodal imaging for detection of clinically inapparent diffuse iris juvenile xanthogranuloma. J Pediatr Ophthalmol Strabismus 2015; 52 Online:e30-3. [PMID: 25992541 DOI: 10.3928/01913913-20150506-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/06/2015] [Indexed: 11/20/2022]
Abstract
A 6-month-old female infant was referred following three episodes of spontaneous hyphema. Iris juvenile xanthogranuloma was suspected but not clinically visible. Multimodal imaging with fluorescein angiography, anterior segment optical coherence tomography, and ultrasound biomicroscopy were used to detect the flat, transparent lesion and cytopathology confirmed juvenile xanthogranuloma.
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Manjandavida FP, Arepalli S, Tarlan B, Shields CL. Optical coherence tomography characteristics of epi-iridic membrane in a child with recurrent hyphema and presumed juvenile xanthogranuloma. J AAPOS 2014; 18:93-5. [PMID: 24568997 DOI: 10.1016/j.jaapos.2013.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/22/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022]
Abstract
We report a case of spontaneous hyphema in a 6-month-old girl with no history of trauma and no visible iris mass. Subtle green-blue heterochromia was noted in the right eye. The iris crypts in the right eye appeared flattened by a thin, transparent layer on the iris surface. Anterior segment optical coherence tomography (AS-OCT) disclosed a thin homogenous membrane overlying the entire iris surface in the right eye. Fluorescein angiography revealed diffuse hyperfluorescence without neovascularization. These features were suggestive of diffuse iris juvenile xanthogranuloma. Sub-Tenon's triamcinolone acetate plus topical corticosteroids eyedrops resolved the condition within 1 month.
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Affiliation(s)
- Fairooz P Manjandavida
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sruthi Arepalli
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bercin Tarlan
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Sadowsky AE. Dermatologic Disorders and the Cornea. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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