Ultra-wide-field retinal imaging in the management of non-infectious retinal vasculitis
1 Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University, Maumenee 745, 600 North Wolfe Street, Baltimore, MD, 21287, USA
2 Department of Ophthalmology, Albert Einstein College of Medicine, Yeshiva University, Montefiore Medical Center, 3332 Rochambeau Avenue, Centennial Building, Bronx, NY, 10467, USA
3 Casey Eye Institute, Oregon Health and Sciences University, 3375 SW Terwilliger Blvd., Portland, OR, 97239, USA
4 Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University, Maumenee 119, 600 North Wolfe Street, Baltimore, MD, 21287, USA
5 Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
Journal of Ophthalmic Inflammation and Infection 2013, 3:30 doi:10.1186/1869-5760-3-30Published: 11 February 2013
The purpose of this study is to describe and quantify the benefit of ultra-wide-field imaging and fluorescein angiography (FA) in the management of non-infectious retinal vasculitis. In this prospective observational cohort series, patients with non-infectious retinal vasculitis were evaluated and enrolled by four investigators from the Divisions of Retina and Ocular Immunology at the Wilmer Eye Institute. In each patient, disease activity and the need for management changes were assessed, based on clinical examination with or without standard (60°) imaging and then with the addition of ultra-wide-field pseudo-color scanning laser ophthalmoscope (SLO) images and FA using the Optos ultra-wide-field SLO (Optos Panoramic 200MA™, Optos PLC, Dunfermline, Scotland, UK). A standardized questionnaire was completed by each investigator at the time of the clinical evaluation.
The primary outcome was the percentage of patients whose management was changed by clinical examination and standard FA, compared with clinical examination plus ultra-wide-field imaging. The secondary outcome was the percentage of patients whose disease was determined to be active based on each modality.
Seventy-one visits from 23 patients were reviewed and analyzed. Based on examination plus ultra-wide-field imaging and ultra-wide-field angiography, disease activity was detected in 48/71 (68%) compared with 32/71 (45%) based on examination and standard FA (P = 0.0095). Based on the clinical examination alone, the decision to alter management was made in 4 of 71 visits (6%), and an additional 3 of 71 (4%) based on simulated standard FA. The addition of ultra-wide-field SLO pseudo-color images altered management in an additional 10/71 visits (14%), and 36/71 (51%) with the addition of ultra-wide-field FA.
Ultra-wide-field fluorescein imaging and angiography can provide additional information that may be important and relevant in the management of retinal vasculitis.