Peripheral Findings and Retinal Vascular Leakage on Ultra-Widefield Fluorescein Angiography in Patients with Uveitis

Abstract

Purpose: To compare ultra-widefield fluorescein angiography (UWFFA) with simulated conventional fluorescein angiography (FA) to evaluate peripheral pathology and leakage and correlate with clinical activity in patients with uveitis.

Design: Retrospective chart review.

Participants: All uveitis patients initially evaluated with UWFFA (Optos 200Tx) between May 2012 and December 2013 were included in this study, including follow-up visits through August 2014.

Methods: Uveitis status was deemed as having active or inactive inflammation based on clinical examination. Changes to therapy, influence on management, and clinical diagnosis were also noted. UWFFA images were compared with simulated 50-degree FA images to evaluate for peripheral lesions, and leakage location was also graded. Imaging characteristics were then correlated with clinical information.

Main outcome measures: Correlation of leakage on UWFFA with clinical inflammation.

Results: An initial set of 243 uveitis patients and a total of 1008 eye images were reviewed. When UWFFA was compared with a simulated 50-degree FA image, UWFFA added additional information regarding the presence of peripheral vascular leakage in 25%, peripheral nonperfusion in 14%, peripheral lesions in 6.6%, and peripheral neovascularization in 3.9% of patients. A total of 600 eye images exhibited fluorescein leakage, of which 21% displayed central leakage only, 11% had central and peripheral leakage, 31% had peripheral leakage only, and 37% had diffuse vascular leakage. Based on peripheral findings on widefield angiography, the treatment was changed in 69 patients (28%). Corresponding eye examinations were reviewed for each imaging session, and of 600 eye images with vascular leakage, 567 eye images were also clinically active, which was 95% sensitive as a surrogate indicator of clinical inflammation. Anterior chamber cell and vitreous haze also significantly correlated with leakage on widefield angiography.

Conclusions: Retinal vascular leakage on UWFFA reveals increased pathology and leakage compared with conventional angiography, which can influence management, and accurately identifies and correlates with active inflammation in patients with uveitis. A more objective measure of inflammation in the form of leakage exhibited on UWFFA may help standardize treatment and care of patients with uveitis.