DETECTION OF TYPE 1 CHOROIDAL NEOVASCULAR MEMBRANES USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN TUBERCULAR POSTERIOR UVEITIS

Retina. 2019 Aug;39(8):1595-1606. doi: 10.1097/IAE.0000000000002176.

Abstract

Purpose: To study optical coherence tomography angiography (OCTA) and multimodal imaging features of Type 1 inflammatory choroidal neovascularization (CNV) in tubercular serpiginous-like choroiditis and response to anti-vascular endothelial growth factor therapy.

Methods: In this study, multimodal imaging was performed using OCTA, enhanced-depth imaging optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Correlation of OCTA with other imaging modalities in the detection of CNV was performed. The changes in CNV configuration after anti-vascular endothelial growth factor therapy were assessed.

Results: In this study, nine eyes (8 patients; 5 females; mean age: 32.5 ± 11.57 years) with diagnosis of tubercular serpiginous-like choroiditis were included. All the eyes had presence of low-lying pigment epithelial detachments on enhanced-depth imaging optical coherence tomography. Using OCTA, it was possible to detect Type 1 CNV in all eyes. Type 1 CNV networks comprised fine anastomotic network of vessels, some of which had a hairpin loop configuration. After anti-vascular endothelial growth factor therapy, there was a decrease in branching and anastomosis. The visual acuity significantly improved from 0.49 ± 0.26 (20/60 Snellen equivalent) at baseline to 0.26 ± 0.17 (20/36 Snellen equivalent) (P = 0.03) in all eyes.

Conclusion: Type 1 CNV can occur among patients with tubercular serpiginous-like choroiditis, leading to significant visual loss even in the healed stages of the disease. Optical coherence tomography angiography can help in the detection of Type 1 CNV where conventional multimodal imaging, including fluorescein angiography and OCT, fails to make a definitive diagnosis and thereby guide the initiation of anti-vascular endothelial growth factor therapy.

MeSH terms

  • Adolescent
  • Adult
  • Angiogenesis Inhibitors / therapeutic use
  • Choroid / blood supply
  • Choroidal Neovascularization / diagnosis*
  • Choroiditis / diagnosis*
  • Choroiditis / microbiology
  • Coloring Agents / administration & dosage
  • Female
  • Fluorescein Angiography
  • Humans
  • Indocyanine Green / administration & dosage
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Tomography, Optical Coherence
  • Tuberculosis, Ocular / diagnosis*
  • Tuberculosis, Ocular / microbiology
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Visual Acuity
  • Young Adult

Substances

  • Angiogenesis Inhibitors
  • Coloring Agents
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Indocyanine Green