ABSTRACT
BACKGROUND/PURPOSE: Quantitative methods for posterior uveitis are necessary for precise appraisal and follow-up of inflammation in practice and in clinical trials. The aim of this study was to assess fluorescein angiography (FA), indocanine green angiography (ICGA), and enhanced depth imaging optical coherence tomography choroidal thickness (EDI-OCT CT) in two stromal choroiditis entities, birdshot retinochoroiditis (BRC), and Vogt-Koyanagi-Harada disease (VKH), as well as to determine (1) disease patterns, (2) respective response to therapy, and (3) their potential utility in clinical trials in comparison to vitreous haze, the present standard outcome used in clinical trials. METHODS: This retrospective study included newly diagnosed patients with BRC and VKH, seen at the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. Angiographic signs were quantified using an established dual FA/ICGA scoring system for uveitis at presentation and on follow-up. FA/ICGA score ratios were compared between diseases to determine disease patterns. EDI-OCT CT was determined using a spectral domain instrument. Vitreous haze was determined using the SUN (Standardization of Uveitis Nomenclature) method. RESULTS: Among 1872 uveitis patients seen from 1995 to 2016, 8 newly diagnosed BRC patients (16 eyes) and 6 newly diagnosed VKH patients (12 eyes) had sufficient data for study inclusion. Patients with BRC and VKH at initial onset had mean FA scores of 16.1 ± 7.0 vs. 4.6 ± 2.1 (p < 0.0001), respectively, while mean ICGA scores were similarly high in the two diseases, 18.9 ± 3.6 (BRC) vs. 20.8 ± 7.5 (VKH). After therapy, FA and ICGA scores decreased significantly for both entities (- 60% of FA score and 55% of ICGA score in BRC vs. - 72% of FA score and - 87% for ICGA score in VKH). EDI-OCT CT decreased significantly in the two entities. Vitreous haze was almost absent in VKH and low in BRC. CONCLUSION: Dual FA/ICGA scoring showed the diverse disease patterns of BRC and VKH; both the retina and choroid were involved at onset in BRC, whereas VKH was a pure choroidal disease with later spillover into the retina. Dual FA/ICGA allowed for the precise measurement of inflammation at onset and upon follow-up. EDI-OCT CT responded to therapy in both diseases but was found to be of limited use in this early/subacute disease phase because it lacked sensitivity to detect subclinical recurrences and was therefore only useful for long-term follow-up. Vitreous haze was low in both entities and thus useless as an inflammatory parameter.
Subject(s)
Angiography/methods , Choroiditis/diagnostic imaging , Fluorescein Angiography/methods , Uveitis, Posterior/diagnostic imaging , Adult , Birdshot Chorioretinopathy , Chorioretinitis/classification , Chorioretinitis/diagnostic imaging , Chorioretinitis/therapy , Choroid/diagnostic imaging , Choroiditis/classification , Choroiditis/therapy , Evaluation Studies as Topic , Female , Humans , Indocyanine Green , Male , Middle Aged , Outcome and Process Assessment, Health Care , Retina/diagnostic imaging , Switzerland , Terminology as Topic , Tomography, Optical Coherence , Uveitis, Posterior/classification , Uveitis, Posterior/therapy , Uveomeningoencephalitic Syndrome/classification , Uveomeningoencephalitic Syndrome/diagnostic imaging , Uveomeningoencephalitic Syndrome/therapy , Vitreous Body/diagnostic imagingABSTRACT
PURPOSE: To validate a scale for grading vitreous haze in uveitis using digitized photographs and standardized scoring. DESIGN: Evaluation of clinical research methodology. METHODS: Calibrated Bangerter diffusion filters inducing incremental decrements of spatial contrast were placed in front of the camera lens while photographing a normal eye to simulate vitreous haze. The photographs were digitized and an ordinal scale was created from 0 (none) to 8 (highest level of opacification at which fundus details could be seen). The scale steps correspond approximately to decimal Snellen visual acuities of 1.0, 0.8, 0.4, 0.2, 0.1, 0.04, 0.02, 0.01, and 0.002, with approximately 0.3 log step between each step. For validation, digitized fundus photographs of uveitis patients were displayed on a computer monitor for comparison with the standard photos. Three observers graded the test set twice under standard conditions. Interobserver and intraobserver variability and κ values for agreement greater than chance were calculated. RESULTS: Variance component analysis determined that 87.7% of the variance in grades was attributable to the test item rather than to grader or session. The intraclass correlation between graders and grading sessions varied from 0.84 to 0.91. Simple agreement within 1 grade between graders and sessions occurred in 90 ± 5.5% of gradings. κ values averaged 0.91, which is considered near perfect. CONCLUSIONS: A 9-step photographic scale was designed to standardize the grading of vitreous haze in uveitis patients using fundus photographs. The scale is potentially adaptable to clinical trials in uveitis.
Subject(s)
Eye Diseases/classification , Photography/classification , Uveitis, Intermediate/classification , Uveitis, Posterior/classification , Vitreous Body/pathology , Humans , Image Processing, Computer-Assisted , Visual Acuity , Young AdultABSTRACT
We describe significant non infectious post operative uveitis after extracapsular cataract extraction (ECCE) with insertion of a posterior chamber intra ocular lens. We observe three forms of evolution: the acute and early uveitis, quickly resolving; the late-occuring uveitis; and the chronic, recurring uveitis, which suggests that the inflammatory response may be caused by the hypersensitivity to the lens protein which remained after the ECCE. So a phako-anaphylactic reaction may occur.