Michael Karampelas1, Dawn A Sim2, Colin Chu2, Ester Carreno3, Pearse A Keane2, Javier Zarranz-Ventura4, Mark Westcott3, Richard W J Lee5, Carlos E Pavesio2. 1. NationaI Institute for Health Research, Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; West Hertfordshire National Health Service Foundation Trust, London, United Kingdom. Electronic address: mikekarampelas@hotmail.com. 2. NationaI Institute for Health Research, Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom. 3. NationaI Institute for Health Research, Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom. 4. NationaI Institute for Health Research, Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; Retinal Unit, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic, Barcelona, Spain; University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom. 5. NationaI Institute for Health Research, Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; School of Clinical Sciences, University of Bristol, Bristol, United Kingdom; University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom.
Abstract
PURPOSE: To investigate the relationships between peripheral vasculitis, ischemia, and vascular leakage in uveitis using ultra-widefield fluorescein angiography (FA). DESIGN: Cross-sectional, consecutive case series. METHODS: 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. RESULTS: 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 (R(2)-adjusted = 0.45, P = .001). CONCLUSIONS: 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.
PURPOSE: To investigate the relationships between peripheral vasculitis, ischemia, and vascular leakage in uveitis using ultra-widefield fluorescein angiography (FA). DESIGN: Cross-sectional, consecutive case series. METHODS: 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. RESULTS: 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 (R(2)-adjusted = 0.45, P = .001). CONCLUSIONS: 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.
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