Multimodal imaging in pediatric uveitis

Abstract

Pediatric uveitis accounts for up to 10% of all uveitis cases, so special attention must be paid to ensure early diagnosis as well as treatment and follow-up of these young patients in order to decrease the risk of possible ocular complications and consequently vision loss. Multimodal imaging has been an effective and important adjunct in the diagnoses and management of uveitis, especially in children. Reviewed here are the currently utilized modalities, advances, as well as their applications in juvenile idiopathic arthritis-associated uveitis, pars planitis, retinal vasculitis, tubulointerstitial nephritis and uveitis syndrome, Behçet disease, Blau syndrome, and Vogt-Koyanagi-Harada syndrome.

Keywords: fluorescein angiography; fundus photography; indocyanine green angiography; optical coherence tomography; uveitis.

Figure 1.

Anterior-segment optical coherence tomography (AS-OCT) demonstrating hyperreflective foci in the anterior chamber (AC) which represents cells in the AC in a 7-year-old female with juvenile idiopathic arthritis–associated uveitis with a Standardization of Uveitis Nomenclature (SUN) Working Group grading criteria of 1+ AC cell.

Figure 2.

Ultra-widefield (UWF) imaging in a 17-year-old female with pars planitis at initial presentation with snowballs of the left eye (a). UWF fluorescein angiography (b) demonstrates mild peripheral vascular leakage associated with snowballs inferiorly.

Figure 3.

Spectral-domain optical coherence tomography (SD-OCT) image in a 12-year-old male with idiopathic panuveitis demonstrating vitreous hyperreflective foci which are representative of vitreous cells.

Figure 4.

Ultra-widefield (UWF) imaging at presentation of an 11-year-old female with bilateral panuveitis demonstrating an unremarkable fundus photograph without any vascular sheathing in the right (a) or left (b) eyes; however, use of UWF fluorescein angiography reveals diffuse (fern-like) vascular leakage in both eyes (c, right eye, d, left eye).

Figure 5.

Ultra-widefield (UWF) imaging in a 16-year-old female with tubulointerstitial nephritis and uveitis (TINU) syndrome demonstrating peripheral circular chororetinal lesions (inset) which have associated hyperfluorescence (staining) on UWF fluorescein angiography.

Figure 6.

Ultra-widefield fundus photography in a 12-year-old male with Blau syndrome demonstrating multifocal chorioretinal scars in both eyes (a, right eye, b, left eye).

Figure 7.

Optic disk photographs in a 5-year-old female with Blau syndrome demonstrating optic disk edema in the right (a) and left (b) eyes.

Figure 8.

Multimodal imaging at presentation in a 15-year-old male with Vogt–Koyanagi–Harada disease. Ultra-widefield (UWF) fundus photography shows scattered areas of serous retinal detachments and disk hyperemia (a). UWF fluorescein angiography shows pinpoint leakage and pooling associated with areas of serous retinal detachment (b). Optical coherence tomography (OCT) demonstrates subretinal and intraretinal fluid nasal to the optic nerve and choroidal undulations (c) and subretinal fluid within the macula (d). Green and red dashed lines in A correspond to areas of the OCT B-scans (c, d, respectively).