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Multiple serous retinal detachments appearing as optically empty spaces between the neurosensory retina and retinal pigment epithelium (RPE) on optical coherence tomography (OCT) scans. Photoreceptors' outer segment elongation is noted in the areas overlying the detachment.
Source publication
Purpose: To analyze choroidal angioarchitecture in sympathetic ophthalmia (SO) using swept-source optical coherence tomography (SS-OCT) images.
Methods: Case–control study of six patients with SO. Qualitative changes and quantitative parameters, including choroidal thickness (CT) and choroidal vascularity index (CVI), were analyzed.
Results: Qualit...
Contexts in source publication
Context 1
... findings in all six patients at baseline are presented in Table 2. SRD appeared on SS-OCT as optically empty spaces between the RPE and neurosensory retina (Figure 1), with hyperreflective septa, presumably made of fibrin, crossing the exudative detachment and giving the appearance of multiple fluid-filled pockets (Figure 2). Interruption in the shedding of photoreceptors resulted in outer segment elongation overlying the SRD (Figure 1). ...
Context 2
... findings in all six patients at baseline are presented in Table 2. SRD appeared on SS-OCT as optically empty spaces between the RPE and neurosensory retina (Figure 1), with hyperreflective septa, presumably made of fibrin, crossing the exudative detachment and giving the appearance of multiple fluid-filled pockets (Figure 2). Interruption in the shedding of photoreceptors resulted in outer segment elongation overlying the SRD (Figure 1). Choroidal alteration on SS-OCT included choroidal undulations, diffuse choroidal thickening, and alterations in the architecture of tissue layers with loss of physiological vascular lacunae (Figure 3). ...
Citations
... 9 Serous retinal detachment associated with bacillary splitting of the outer retina and massive choroidal thickening with folds have often been observed in SO, similarly to the early chorioretinal manifestations of Vogt-Koyanagi-Harada (VKH) disease. 5,16,17 Optic disc swelling is another common finding in the acute phase and might contribute to the high prevalence of peripapillary fibrosis seen chronically. 3 Macular edema can also be present in active cases. ...
Purpose: To report the clinical and multimodal imaging features of sympathetic ophthalmia in the acute and chronic phases.Methods: Retrospective cohort study of consecutive patients with sympathetic ophthalmia seen at a tertiary referral center. Charts, imaging studies, and histopathological specimens were reviewed. The clinical features and multimodal imaging in the sympathizing eye were analyzed by sorting features into those seen in the acute and chronic phase.
Results: Ten patients were included in the analysis, and all of them had previous ocular trauma or complicated retinal detachment. In the acute phase, 70% had anterior uveitis, 70% had vitritis and 100%had active posterior uveitis; posterior uveitis included multifocal choroiditis (80%), optic disc swelling(40%), multiple serous retinal detachments (20%), MEWDS-like findings (10%), and retinal vasculitis with chorioretinitis (10%). In the chronic phase, posterior manifestations included widespread patches of chorioretinal atrophy in the mid- and far-periphery (80%), peripapillary subretinal fibrosis (50%), and nummular perivascular atrophy (50%).
Conclusions: Sympathetic ophthalmia shows different posterior segment manifestations in the acute and chronic phase. Active sympathetic ophthalmia should be ruled out in eyes with a MEWDS-like presentation or rapidly progressing chorioretinitis and a history of trauma in the fellow eye. Peripapillary subretinal fibrosis and perivascular nummular atrophy may be useful features to suspect SO once acute inflammation has resolved.
... Studies have emphasized the importance of using EDI-OCT in SO patients, both in evaluating the response to treatment in patients presenting with exudative RD and in detecting early changes in asymptomatic patients. 17,19,20 Choroidal thickness was also reported to be a good biomarker for monitoring disease activity in VKH. 18 Behdad et al. 19 detected choroidal thickening during the acute phase in a young man with SO and observed that choroidal thickness decreased with treatment. ...
Objectives:
To evaluate the demographic characteristics, clinical findings, and treatment approach of patients with sympathetic ophthalmia (SO).
Materials and methods:
The records of 14 patients with SO between 2000 and 2020 were retrospectively reviewed. The patients' Snellen best corrected visual acuity (BCVA), detailed ophthalmological examination, optical coherence tomography (OCT), enhanced depth imaging-OCT (EDI-OCT), fundus fluorescein angiography findings, and treatment approaches were recorded.
Results:
The study included the 14 sympathizing eyes of 14 patients with SO (7 female, 7 male). The mean age was 48.5±15.4 years (range: 28-75), and the mean follow-up duration was 55.1±48.7 months (range: 6-204). Ten patients (71%) had a history of ocular trauma and 4 (29%) had a history of ocular surgery. The time to symptom onset in the sympathizing eye after trauma or ocular surgery ranged from 15 days to 60 years. The most common posterior segment findings were optic disc edema (36%) and exudative retinal detachment (36%). In the acute period, the mean choroidal thickness value on EDI-OCT was 716.5±63.6 μm (range: 635-772) and decreased to 296±81.6 μm (range: 240-415) after treatment. Treatment with high-dose systemic corticosteroid was given to 8 patients (57%), azathioprine (AZA) to 7 (50%), AZA and cyclosporine-A combination to 7 (50%), and tumor necrosis factor-alpha inhibitors to 3 patients (21%). Recurrence was observed in 4 patients (29%) during follow-up. At last follow-up, BCVA values were better than 20/50 in 11 (79%) of the sympathizing eyes. Remission was achieved in 13 patients (93%), but 1 patient (7%) lost her vision due to acute retinal necrosis.
Conclusion:
SO is a bilateral inflammatory disease that presents with granulomatous panuveitis after ocular trauma or surgery. Favorable functional and anatomical results can be obtained with early diagnosis and initiation of appropriate treatment.
... In the acute phase of sympathetic ophthalmia, thicker choroid and increased CVI were noticed based on SS-OCT imaging. 159 By assessing structural CT change after systemic corticosteroid therapy in Vogt-Koyanagi-Harada (VKH), significantly increased CT in the area with pretreatment CT of less than 100 μm and significantly decreased CT in the area with pretreatment CT of more than 300 μm were noticed, indicating choroidal remodeling. 160 Inflammatory CNV (iCNV) is a common complication of posterior uveitis. ...
Background
The fast development of swept-source optical coherence tomography (SS-OCT) and swept-source optical coherence tomography angiography (SS-OCTA) enables both anterior and posterior imaging of the eye. These techniques have evolved from a research tool to an essential clinical imaging modality.
Main text
The longer wavelength and faster speed of SS-OCT and SS-OCTA facilitate better visualization of structure and vasculature below pigmented tissue with a larger field of view of the posterior segment and 360-degree visualization of the anterior segment. In the past 10 years, algorithms dealing with OCT and OCTA data also vastly improved the image quality and enabled the automated quantification of OCT- and OCTA-derived metrics. This technology has enriched our current understanding of healthy and diseased eyes. Even though the high cost of the systems currently limited the widespread use of SS-OCT and SS-OCTA at the first beginning, the gap between research and clinic practice got obviously shortened in the past few years.
Conclusions
SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift toward more widespread adoption of new imaging technology in clinical practice.
... [1] The presence of those dots needs to be reconfirmed and compared with other stromal choroiditis particularly sympathetic ophthalmia (SO). [4] If they are more characteristic for the VKH, they may be a new OCT image biomarker in acute VKH. Retinal pigment epithelium (RPE) undulations were seen in 21 eyes (61.7%) and posterior vitreous cells in 34 eyes (100%). ...
... SS-OCT and its advancement are important imaging tools in patients of VKH. [1][2][3][4][5][6][7][8][9] SS-OCT is a non-invasive histological representation of retino-choroidal microstructures in stromal choroiditis. [1][2][3][4][5][6][7][8][9] Stages of VKH can be studied using this advanced imaging technique, and recent OCT imaging biomarkers for disease-specific conditions can help ophthalmologists and subject experts to diagnose them accurately. ...
... [1][2][3][4][5][6][7][8][9] SS-OCT is a non-invasive histological representation of retino-choroidal microstructures in stromal choroiditis. [1][2][3][4][5][6][7][8][9] Stages of VKH can be studied using this advanced imaging technique, and recent OCT imaging biomarkers for disease-specific conditions can help ophthalmologists and subject experts to diagnose them accurately. [1][2][3][4][5][6][7][8][9] Dipankar Das, Priyank Bhola 1 , Obaidur Rehman 1 Ocular Pathology, Uveitis and Neuroophthalmology Services, 1 Departmant of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India ...
... Compared to the spectral domain OCT (SD-OCT), it offers improved tissue penetrance and acquisition at double speed, providing a clearer image [5]. Although OCT is an exploratory technique that is frequently used to study retinochoroidal inflammatory pathologies [6,7], its usefulness has been less often described in anterior segment (AS) inflammatory entities. Recently, iris structure AS-OCT findings have been published in cases of bilateral acute depigmentation of the iris (BADI) [8] and albinism [9]. ...
Purpose
To compare iris affectation in cytomegalovirus anterior uveitis (CMVAU), rubella virus-associated uveitis (RVU), and healthy contralateral eyes, using swept-source anterior segment optical coherence tomography (SS-AS-OCT).
Materials and methods
A comparative, transversal, retrospective study examining 60 eyes from 30 patients—18 eyes (17 patients) with CMVAU, 14 eyes (13 patients) with RVU, and 28 healthy eyes—was performed. Six-millimeter cross-sectional SS-AS-OCT B-scans were obtained in each iris quadrant. Images were exported to ImageJ®. Qualitative and quantitative analyses were done: stromal thickness (ST), smooth index (SI), and optical density (OD) of pigment epithelium. Comparisons between measurements and clinical-demographic parameters were performed using SPSS®.
Results
Qualitative analysis showed extensive damage in iris stroma but was unable to differentiate between both uveitis. RVU eyes had a lower mean ST (315.72 μm ± 42.4) compared to those with CMVAU (348.6 μm ± 46) (p = 0.047) and a lower ST in the upper (338.9 μm ± 38.52)/(386.25 μm ± 47.2) (p = 0.005) and temporal (281.5 μm ± 57.3)/(326.43 μm ± 62.3) (p = 0.016) quadrants. Mean (0.94 ± 0.02)/(0.9 ± 0.03) (p = 0.001), temporal (0.94 ± 0.02)/(0.89 ± 0.03) (p < 0.001), and nasal SI (0.094 ± 0.02)/(0.9 ± 0.04) (p = 0.005) were higher in RVU. OD was similar in both uveitis. In healthy eyes, mean ST (376.8 μm ± 39.7) was higher and mean SI was lower (0.87 ± 0.04) than in RVU (p < 0.001) and CMVAU eyes (p = 0.032). Mean OD was higher in healthy eyes (911 ± 130) than in CMVAU eyes (800 ± 200) (p = 0.037).
Conclusions
The quantitative analysis of the SS-AS-OCT iris images allows for the differentiation between healthy eyes and those with CMVAU and RVU, as well as between both uveitis.
... Choroidal vascularity index is regarded as a stable index and is less influenced by physiological factors. [56] Optical coherence tomography angiography (OCTA) Multiple small areas of choriocapillaris flow voids that likely correspond to areas of choriocapillaris ischemia, which decrease in size and disappear with treatment, have been observed in OCTA [ Fig. 12]. [57] Choroidal neovascular membrane can also be better visualized with the help of OCTA. ...
Sympathetic ophthalmia is a rare, bilateral, granulomatous, panuveitis following penetrating trauma or surgery to one eye. Clinical presentation commonly occurs within the first year of trauma occurrence but can be delayed by several years. It manifests as acute/chronic granulomatous uveitis with yellowish-white choroidal lesions or Dalen-Fuchs nodules. Initially, patients respond rapidly to corticosteroid therapy, but a majority require long-term use of corticosteroid-sparing agents to prevent recurrences. The purpose of this review is to elaborate on the current understanding of the pathophysiology, the importance of multimodal imaging in early diagnosis, and the role of newer immunomodulatory and biological agents in recalcitrant cases.
... Dye-based techniques like fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) are crucial to assess the areas with activity and thereby indicate disease extension [11]. However, being invasive, these are associated with rare complications like anaphylaxis [12]. Also, as FFA displays only the innermost retinal layer [8], and ICGA, the choroidal layers [11], depth resolved analysis of these layers using these techniques becomes impossible. ...
... OCT angiography (OCTA is a non-invasive imaging technique that allows depth-resolved quantitative information on the blood flow of the retina and choroid [15][16][17]. OCTA has been used to assess the changes in retinal and choroidal blood flow in many inflammatory diseases [12,18,19], although the inability to detect leakage is a major limiting factor. The ability to detect changes in the choriocapillaris (CC) structure, especially in inflammatory conditions is an additional advantage to document the visual prognosis owing to its blood supply to the outer retinal layers, especially to the macular region [20,21]. ...
... The analysis of CVI in this study adds further relevance to the choroidal changes in these eyes. CVI provides generalized information on choroidal vascularity and remains unaffected by physiological factors [12]. It was reported as a robust biomarker in a few uveitic conditions [12,18,19]. ...
Aim
To analyse the alterations in retino-choroidal angioarchitecture in eyes with active tubercular serpiginous-like choroiditis (TB-SLC) using swept-source optical coherence tomography angiography (SS-OCTA).
Methods
This prospective cross-sectional study enrolled 34 eyes diagnosed with TB-SLC and 34 age-matched healthy controls. Data acquisition with SS-OCTA using the PLEX Elite 9000 (Carl Zeiss Meditec Inc., Dublin, CA, USA) with a 6 × 6 mm pattern centered on the foveal center was done. Automated retinal vessel length density (VLD) and perfusion density (PD) and foveal avascular zone architecture were obtained from the ARI hub. Choroidal vascularity index (CVI) and choriocapillaris flow deficits (CCFD) were obtained using Image J.
Results
Eyes with TB-SLC showed significantly reduced vessel indices in all retinal layers (P < 0.05), decreased CVI (P = 0.001) and increased CCFD (P = 0.001) as compared to healthy eyes. CCFD was increased significantly in the involved quadrants in eyes with TB-SLC when compared with the uninvolved quadrants and corresponding healthy quadrants in control subjects. CCFD showed a significant negative correlation with visual acuity (r = − 0.46, P = 0.006).
Conclusion
Eyes with TB-SLC manifest reduced VLD and PD, decreased CVI and increased CCFD. The CCFD alterations are non-uniform in these eyes, mainly located under the regions with disease activity.
... Previous OCT studies of small numbers of patients initially revealed SRD with choroidal thickening in the acute stage of PSO [9][10][11]. However, the clinical and OCT features of PSO are still poorly understood. ...
Background
To investigate the clinical manifestations, visual outcomes and optical coherence tomographic (OCT) features of patients with posterior sympathetic ophthalmia (PSO).
Methods
We performed a retrospective review of 48 patients diagnosed with PSO between January 2013 and December 2019. We compared the clinical and OCT features among different clinical types of PSO.
Results
PSO could be classified into two types according to whether the fundus exhibited serous retinal detachment (SRD) or multifocal choroiditis (MFC). There were 41 patients (85.4%) with SRD and 7 patients (14.6%) with MFC. The latent period of patients with MFC was significantly longer than that of patients with SRD ( P = 0.002). The final visual acuity of patients with MFC was significantly worse than that of patients with SRD ( P = 0.0001). In patients with acute SRD, OCT revealed that the mean height of retinal detachment in the fovea was 528.8 ± 437.5 μm. After treatment, the retina reattached in all patients and the band structures of the outer retina were restored in most patients (92.7%). In patients with acute MFC, the OCT images revealed inflammatory lesions on the retinal pigment epithelium layer. After treatment, the OCT images showed hyperreflective fibrosis of the lesions and loss of the outer retinal band structures in all patients.
Conclusions
We found that PSO could be classified according to the presence of SRD or MFC. The visual prognosis differed significantly between these types of PSO. OCT imaging is useful for clinical classification and monitoring of retinal changes after treatment.
... Several studies have shown that CVI is a useful OCT marker in different intraocular inflammatory conditions primarily in posterior uveitis diseases. [7][8][9][10][11] Previous studies have suggested choroidal involvement in IU but the extent of choroidal involvement in IU remains unclear. [12][13][14] Histopathologic studies of pars planitis eyes have demonstrated inflammatory infiltration of the choroidal stroma. ...
... 18 Studies using CVI in various causes of uveitis showed that CVI can be used to identify longitudinal changes, particularly in posterior or panuveitis. 6,[8][9][10][11][19][20][21] However, longitudinal changes in CVI in patients with IU remain unknown. ...
Purpose:
To investigate the longitudinal changes in choroidal vascularity index (CVI) in eyes with active and quiescent intermediate uveitis using enhanced depth imaging optical coherence tomography (EDI-OCT).
Methods:
EDI-OCT images of eyes with active and quiescent intermediate uveitis were retrospectively reviewed and binarized using ImageJ software. Choroidal parameters including CVI, total choroidal area (TCA), luminal area (LA), stromal area (SA), and subfoveal choroidal thickness (SCT) were measured and compared between baseline and follow-up visits among eyes with active and quiescent intermediate uveitis.
Results:
Thirty-eight eyes from 21 patients with active intermediate uveitis and 30 eyes from 17 patients with quiescent intermediate uveitis were included. CVI in eyes with active intermediate uveitis significantly increased from baseline (66.50% ± 3.40%) with resolution of inflammation on follow-up (68.82% ± 3.90%; P < 0.001). In eyes with quiescent intermediate uveitis at baseline eyes, CVI did not significantly change after follow-up (66.34% ± 3.19% to 66.25% ± 3.13%; P = 0.850).
Conclusions:
CVI significantly increased when active inflammation in intermediate uveitis resolved while CVI remained unchanged at follow-up in quiescent intermediate uveitis.
Translational relevance:
CVI may be a useful noninvasive tool to monitor treatment response in intermediate uveitis. Our findings also highlight the involvement of choroidal vasculature in uveitic eyes without any clinical evidence of choroiditis.
... 10,11 A recent method that involves the in vivo quantification of choroidal vasculature through the binarization of spectral-domain optical coherence tomography images has been introduced to facilitate further analysis of retinal and choroidal diseases. [11][12][13][14][15][16][17][18][19] The aforementioned method allows the estimation of new choroidal biomarkers, namely, the total choroidal area, stromal area, luminal area, and choroidal vascularity index, which is defined as the ratio of the luminal area to the total choroidal area. 11 To the best of our knowledge, the aforementioned technique has not been used in the examination of papilledema patients who might exhibit alterations in the choroidal vasculature. ...
... Most of the current studies that investigate the choroidal vascularity index and other choroidal vascular parameters are mainly focused on the retinal and choroidal disorders or the effects of various diseases on the subfoveal and submacular choroidal anatomy. 11,13,14,16,18,19,[21][22][23][24][25] The aforementioned studies involving choroidal image binarization generally show an increased choroidal 16,23,26 In addition, few studies that evaluate the peripapillary choroidal parameters, especially peripapillary choroidal vascularity index in conditions associated with the optic nerve, such as arteritic and nonarteritic anterior ischemic optic neuropathy, 17,27 glaucoma, 28 and β zone parapapillary atrophy, 15 have been reported in literature. ...
Significance:
Choroidal vascularity index measured by image binarization method from peripapillary optical coherence tomography sections has been found significantly lower in papilledema patients than healthy controls.
Purpose:
The purpose of this study was to compare peripapillary choroidal parameters in papilledema patients with control subjects.
Methods:
Peripapillary spectral domain optical coherence tomography scans of 34 patients with papilledema and 34 healthy controls are acquired for the study. Images are binarized with the ImageJ software (National Institutes of Health, Bethesda, MD) to calculate total choroidal area, stromal area, luminal area, and choroidal vascularity index.
Results:
Total choroidal area, luminal area, and choroidal vascularity were significantly lower in papilledema patients compared with healthy controls on right (1.343 ± 0.286 vs. 1.694 ± 0.344, P < .001; 0.880 ± 0.209 vs. 1.167 ± 0.255, P < .001; 65.28 ± 2.99% vs. 68.68 ± 2.81%, P < .001, respectively) and left eyes (1.376 ± 0.308 vs. 1.647 ± 0.339, P < .001; 0.899 ± 0.231 vs. 1.134 ± 0.237, P < .001; 64.92 ± 3.44 vs. 68.84 ± 3.23, P < .001, respectively). No difference was found between active and remitted stages of papilledema in terms of choroidal parameters.
Conclusions:
Peripapillary total choroidal area, luminal area, and choroidal vascularity index are significantly reduced in patients with papilledema. These parameters might be beneficial tools for evaluating choroidal vascularity in papilledema quantitatively and differential diagnosis for optic disc edema.
