First Author: R.Vala INDIA
Co Author(s): P. Mahendradas A. Kawali R. Shetty
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To study adaptive optics imaging (AOI) and its correlation with fundus photo (FP) and fluorescein angiography (FA) in diagnosis of Perivascular sheathing in Retinal Vasculitis and its usefulness in monitoring the disease activity.
We conducted our study at Narayana Nethralaya Eye Hospital, Bangalore, India in the Department of Uvea.
We conducted a single centre clinical, prospective and observational case study in patients with retinal vasculitis. The study consisted of 6 patients with Behcet’s disease (n=1), Systemic Lupus Erythematosus (n=1), Idiopathic Retinal Vasculitis (n=2), Granulomatosis with Polyangitis(n=1), Takayasu Aorta Arteritis (n=1).The inclusion criteria included a confirmed diagnosis of the respective disease and a lack of a diagnosis was excluded from our study. After complete ophthalmic examination, fundus photograph (FP), fluorescein angiography (FA) and adaptive optics imaging (AOI) were done. The perivascular sheathing and the wall-to-wall diameter of the vessel involved were measured at presentation and on follow up. The image analysis of the acquired image was then performed using Image J software
In our study, the age group of patients ranged from 11 years to 59 years with majority of patients being male (n=4). The anterior segment findings in cases of Idipathic retinal vasculitis and Microscopic Polyangitis showed fine Keratic Precipitates while the rest of the cases had a normal anterior segment. The posterior segment finding of vitritis and perivascular sheathing, suggestive of Retinal Vasculitis was present in all cases. These posterior segment findings were in correlation with the findings of respective FP, FA and AOI. The FP, FFA and AO were seen to colocalise in all the patients except in one case of Takayasu Aorta Arteritis where AOI picked up the sheathing whereas FP and FA failed to pickup the same. A complete resolution was seen in case of Idiopathic Retinal Vasculitis (I) ,Granulomatosis with Polyangiits and Takayasu Arteritis
AOI is a useful additional investigational tool for studying the retinal vasculature of patients with retinal vasculitis in addition to FP and FA .The AOI findings of the posterior segment in retinal vasculitis correlates with the corresponding FP and FA in our study. Moreover, in some patients in whom repeated FA cannot be performed, AOI can prove to be a useful diagnostic tool. It can also be used to demonstrate the subclinical stage of disease, which could be missed on FP and FA like in our patient with Takayasu Arteritis. With this new technology, we can even monitor the disease course and can modify our treatment regimen accordingly.