scholarly journals The evaluation of the efficacy of adalimumab in refractory non-infectious uveitis with ultra-widefield fundus fluorescein angiography

Author(s):  
Dilek Uzlu ◽  
Büşra Köse ◽  
Nurettin Akyol ◽  
Hidayet Erdöl ◽  
Murat Günay
2021 ◽  
Author(s):  
Dilek UZLU ◽  
Büşra Köse ◽  
Nurettin Akyol ◽  
Hidayet Erdöl ◽  
Murat Günay

Abstract Aim: To investigate the efficacy of adalimumab in the cases with refractory non-infectious uveitis and evaluate retinal vascular leakage changes on ultra-widefield fundus fluorescein angiography.Methods: Twenty-three patients with refractory uveitis were included in study. Results: Forty-four eyes of 23 patients with non-infectious uveitiswere evaluated. Clinically active inflammation was present in 19 eyes (43.18%), while 25 (56.8%) were inactive. The mean drug burden was a 9.91±3.78 (5-21) in baseline, 7.3±4.25 at third and 8.0±4.71 at sixth month (p=0.022). The mean choroidal thickness was 256.65±43.63 μm in baseline, 240.49±36.73 μm at third and 224.81±34.91 μm at sixth month (p≤0.05). In terms of leakage extend, leakage was initially present in a mean of 2.95±4.55 clock hour quadrants, 2.41±3.91 at thirdand 1.76±3.44 at sixth month (p<0.001). Conclusion: Adalimumab was found to be effective in establishing inflammation control by reducing drug burden, controlling retinal vascular leakage and choroidal inflammation in refractory uveitis.


Author(s):  
Ketaki Rajurkar ◽  
Meenakshi Thakar ◽  
Priyadarshi Gupta ◽  
Anju Rastogi

Abstract Purpose To study the macular features in Eales disease patients observed with fundus fluorescein angiography (FA), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods A cross-sectional study was done on treatment naïve 31 eyes (23 patients) with Eales disease. Baseline parameters such as Best-corrected visual acuity (BCVA), slit-lamp bio microscopy (SLB), indirect ophthalmoscopy, FA, spectral-domain OCT {quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT} and OCTA were performed. Any media opacity precluding the above investigations was excluded. Results Macular findings comprised of- epiretinal membrane, macular exudation, full thickness macular hole, sub internal limiting membrane bleed, cystoid macular oedema, neurosensory detachment and retinal thickening. Sixteen (51.6%) of our patients had macular changes as seen on all modalities together. SLB and indirect ophthalmoscopy missed macular findings in 50% patients and FA in 18.8% patients. OCT and OCTA diagnosed all macular findings. On comparison of mean BCVA in patients with macular involvement on FA, OCT and OCTA, compared to those without macular involvement, patients with macular involvement had lower BCVA (p 0.000, 0.01 and 0.001 respectively). Thus, FA missed many patients who had significant macular involvement and hence less vision. Conclusion Eales disease though described in literature as classically being peripheral retina disease process, also has macular involvement. OCT and OCTA are useful guides to evaluation of macular involvement in these patients. The latter seems to be superior to FA in detecting macular abnormalities in this ailment. OCTA is non-invasive and shows deep capillary plexus changes which are not shown by any other modality.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nayera H El Sherif ◽  
Mahmoud A Kenny ◽  
Waheed S Elhalfawy

Abstract Background Sickle cell disease can affect retina of eye via vaso-occulsive changes that occur in micro-vessels of retina which could be analysed by using Fundus Fluorescein Angiography. Aim To analyze macular microvascular alternation in patients with SCD by Fundus Fluorescein Angiography (FFA) and to assess the role of potentially contributory Clinico-pathological factors including Trans-Cranial Doppler, genotypes, hydroxyurea, transfusion therapy and finally iron overload state on the development of macular alterations. Method This was across-sectional study which included 30 Sickle cell disease patients randomly recruited from the Paediatric Haematology clinic, children Hospital, Ain Shams University, Cairo, Egypt. Complete blood count (CBC), Trans-Cranial Doppler (TCD) and Fundus Fluorescein Angiography. Results In our study, there were 30 patients with mean age (14.1± 4.02), 5 patients had abnormal/conditional Trans-Cranial, 15 patients had Vaso-occlusive crises, 11 patients were on regular simple blood transfusion; all 30 studied sickle cell disease patients had normal Fundus Fluorescein Angiography and eye examination and only one patient hadabnormal visual acuity;A 29 years oldgirl who had five attacks of cerebral strokes last year, on regular simple blood transfusion and Hydroxyurea treatment with abnormal TCD and recurrent Vaso-occlusive crises in last two years, Although her vision is hand movement yet Fundus Fluorescein Angiography was normal. Conclusion we didn’t find any Retinal microvascular alternation in our studied SCD patients using Fundus Fluorescein Angiography, we related our results to the fact that our studied SCD patients were young and all our studied patients were on hydroxyurea therapy with fair compliance, further studies using large sample size are warranted in order to illustrate the utility of Fundus Fluorescein Angiography (FFA) as a tool for better detection of sickle retinopathy.


In Behcet's disease, the anterior and posterior segments of the eye may be affected separately or together. Fundus fluorescein angiography should be performed in addition to ophthalmoscopic examination for early diagnosis and treatment of ocular involvement. Fundus fluorescein angiography (FFA) is the gold standard for the evaluation of the retinal vascular system and pathologies. Fundus fluorescein angiography is more sensitive than fundus examination in the detection of vasculitis, and angiographic involvement is always more common than clinical involvement. Fluorescein angiography may reveal leakage from retinal veins in eyes whose visual impression is not affected and the fundus examination is normal. The absence of vascular leakage with fluorescein angiography indicates that the disease is in a completely inactive period. Because of the development of blindness due to posterior segment involvement, early detection of the disease with fundus angiography and the initiation of the treatment is successful in terms of visual prognosis. It has an important place in terms of early activation of patients with FFA in the early diagnosis of eye involvement and follow-up of the disease and treatment. Wide-field imaging angiography imaging of the retinal periphery revealed the importance of lesions in retinal periphery and peripheral areas invisible by standard angiography. The use of indocyanine green angiography in Behcet uveitis is limited.


Even though the diagnosis depends on clinical examination, in cases with branch retinal vein occlusion (BRVO), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) provide unique data for follow-up, management and prognosis. In FFA, delay of laminar flow phase in the involved branch, hyperfluorescence due to leakage from the vessel wall in the late phases, hypofluorescence due to the blockage by hemorrhage, and soft exudates, and hyperfluorescence due to macular edema can be detected. In OCT, macular thickening, cystic spaces, serous retinal detachment, hyperreflective dots, disorganization of the outer retinal layers – particularly the photoreceptor inner and outer segments line and the external limiting membrane – can be seen. OCTA reveals non-perfusion, particularly in the deep capillary plexus.


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