Swept source OCTA reveals a link between choriocapillaris blood flow and vision loss in a case of tubercular serpiginous-like choroiditis

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Abstract

Optical coherence tomography angiography (OCTA) is a non-invasive technique that is useful in the diagnosis and management of patients with posterior uveitis. Here we report the use of swept source OCTA (SS-OCTA) in a patient with tuberculosis (TB) associated serpiginous like choroiditis (TB-SLC) that made a full visual recovery following treatment with ATT, local and systemic corticosteroids, and systemic immune modulation. By comparing en face images of choriocapillaris (CC) blood flow before and after treatment, we conclude that the patient's visual recovery was associated with resolution of extensive CC flow deficits. This case highlights the utility of SS-OCTA in the multimodal evaluation of patients with choroidal inflammation, and the potential for good visual recovery in patients treated for TB-SLC.

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Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications.

Amir Kashani, Chieh-Li Chen, Jin Gahm … (2017)

OCT has revolutionized the practice of ophthalmology over the past 10-20 years. Advances in OCT technology have allowed for the creation of novel OCT-based methods. OCT-Angiography (OCTA) is one such method that has rapidly gained clinical acceptance since it was approved by the FDA in late 2016. OCTA images are based on the variable backscattering of light from the vascular and neurosensory tissue in the retina. Since the intensity and phase of backscattered light from retinal tissue varies based on the intrinsic movement of the tissue (e.g. red blood cells are moving, but neurosensory tissue is static), OCTA images are essentially motion-contrast images. This motion-contrast imaging provides reliable, high resolution, and non-invasive images of the retinal vasculature in an efficient manner. In many cases, these images are approaching histology level resolution. This unprecedented resolution coupled with the simple, fast and non-invasive imaging platform have allowed a host of basic and clinical research applications. OCTA demonstrates many important clinical findings including areas of macular telangiectasia, impaired perfusion, microaneurysms, capillary remodeling, some types of intraretinal fluid, and neovascularization among many others. More importantly, OCTA provides depth-resolved information that has never before been available. Correspondingly, OCTA has been used to evaluate a spectrum of retinal vascular diseases including diabetic retinopathy (DR), retinal venous occlusion (RVO), uveitis, retinal arterial occlusion, and age-related macular degeneration among others. In this review, we will discuss the methods used to create OCTA images, the practical applications of OCTA in light of invasive dye-imaging studies (e.g. fluorescein angiography) and review clinical studies demonstrating the utility of OCTA for research and clinical practice.

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Comparison Between Spectral-Domain and Swept-Source Optical Coherence Tomography Angiographic Imaging of Choroidal Neovascularization

C Miller, Luiz Roisman, Qinqin Zhang … (2017)

Purpose The purpose of this study was to compare imaging of choroidal neovascularization (CNV) using swept-source (SS) and spectral-domain (SD) optical coherence tomography angiography (OCTA). Methods Optical coherence tomography angiography was performed using a 100-kHz SS-OCT instrument and a 68-kHz SD-OCTA instrument (Carl Zeiss Meditec, Inc.). Both 3 × 3- and 6 × 6-mm2 scans were obtained on both instruments. The 3 × 3-mm2 SS-OCTA scans consisted of 300 A-scans per B-scan at 300 B-scan positions, and the SD-OCTA scans consisted of 245 A-scans at 245 B-scan positions. The 6 × 6-mm2 SS-OCTA scans consisted of 420 A-scans per B-scan at 420 B-scan positions, and the SD-OCTA scans consisted of 350 A-scans and 350 B-scan positions. B-scans were repeated four times at each position in the 3 × 3-mm2 scans and twice in the 6 × 6-mm2 scans. Choroidal neovascularization was excluded if not fully contained within the 3 × 3-mm2 scans. The same algorithm was used to detect CNV on both instruments. Two graders outlined the CNV, and the lesion areas were compared between instruments. Results Twenty-seven consecutive eyes from 23 patients were analyzed. For the 3 × 3-mm2 scans, the mean lesion areas for the SS-OCTA and SD-OCTA instruments were 1.17 and 1.01 mm2, respectively (P = 0.047). For the 6 × 6-mm2 scans, the mean lesion areas for the SS-OCTA and SD-OCTA instruments were 1.24 and 0.74 mm2 (P = 0.003). Conclusions The areas of CNV tended to be larger when imaged with SS-OCTA than with SD-OCTA, and this difference was greater for the 6 × 6-mm2 scans.

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Long-term follow-up of patients with serpinginous choroiditis.

Nancy J Christmas, Kean T Oh, Dawn M Oh … (2002)

To evaluate the long-term clinical course of serpiginous choroiditis-a recurrent inflammatory disease that causes progressive visual loss-and to determine the efficacy of immunosuppressive therapy. A retrospective study of patients who met inclusion criteria for serpiginous choroiditis at The University of Iowa Hospitals and Clinics was performed. Information collected included duration of follow-up, number of recurrences of inflammation, visual acuities, and development of choroidal neovascularization. The number of recurrences of inflammation in patients treated with immunosuppressive agents was compared with that in patients treated only with corticosteroids or observation. Seventeen patients were identified who had a mean age at presentation of 39.6 years. The mean duration of follow-up was 149.2 months, with 13 patients who were followed up for >60 months. Twelve eyes either presented with or developed macular choroidal neovascularization during follow-up. Thirteen of the patients were followed up for >12 months. Of these 13 patients, 6 received treatment with immunosuppressive agents along with corticosteroids. Four of the six patients developed no further inflammatory recurrence. Seven of the 13 patients were treated with corticosteroids or observation. All of these patients developed recurrences (P = 0.021, Fisher exact test). Immunosuppressive agents appear to reduce the rate of recurrent disease in serpiginous choroiditis compared with corticosteroids.

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Author and article information

Contributors

Kathryn L. Pepple

Journal

Journal ID (nlm-ta): Am J Ophthalmol Case Rep

Journal ID (iso-abbrev): Am J Ophthalmol Case Rep

Title: American Journal of Ophthalmology Case Reports

Publisher: Elsevier

ISSN (Electronic): 2451-9936

Publication date PMC-release: 25 January 2021

Publication date Collection: March 2021

Publication date (Electronic): 25 January 2021

Volume: 21

Electronic Location Identifier: 101018

Affiliations

[a ]University of Washington, Department of Ophthalmology, Seattle, WA 98104, USA

[b ]Department of Bioengineering, University of Washington, Seattle, WA 98195, USA

Author notes

[∗ ]Corresponding author. 908 Jefferson St, Seattle, WA, 98104, USA. kpepple@ 123456uw.edu

Article

Publisher Item ID: S2451-9936(21)00009-8 Publisher ID: 101018

DOI: 10.1016/j.ajoc.2021.101018

PMC ID: 7851177

SO-VID: e6112b1f-d305-4e2e-a914-c56862d3f61e

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 17 May 2020

Date revision received : 20 October 2020

Date accepted : 11 January 2021

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Swept source OCTA reveals a link between choriocapillaris blood flow and vision loss in a case of tubercular serpiginous-like choroiditis

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European Journal of Medical Case Reports (EJMCR)

Most cited references 17

Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications.

Comparison Between Spectral-Domain and Swept-Source Optical Coherence Tomography Angiographic Imaging of Choroidal Neovascularization

Long-term follow-up of patients with serpinginous choroiditis.

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