Pakzad-Vaezi Kaivon, Khaksari Kosar, Chu Zhongdi, Van Gelder Russell N, Wang Ruikang K, Pepple Kathryn L
Department of Ophthalmology, University of Washington, Seattle, WA 98104.
Department of Bioengineering, University of Washington, Seattle, WA 98195.
Ophthalmol Retina. 2018 Jul;2(7):712-719. doi: 10.1016/j.oret.2017.11.001. Epub 2017 Dec 29.
To examine and quantify choriocapillaris lesions in active and quiescent serpiginous choroiditis (SC) using swept-source optical coherence tomography angiography (SS-OCTA) and en-face image analysis.
Prospective observational case series.
Patients with a clinical diagnosis of SC.
A SS-OCTA prototype was used to image active and quiescent serpiginous lesions longitudinally before and after anti-inflammatory treatment. En-face slabs of choriocapillaris flow (CC-slab) or outer nuclear layer structure (ONL-slab) were generated from OCTA and OCT data, respectively.
Qualitative and quantitative analyses on lesion boundary and area using a semi-automated MATLAB algorithm. Lesions were also compared to traditional multimodal imaging.
Six eyes of three patients were imaged. Choroidal lesions were identified and analyzed in four of six eyes. Lesions with well-defined boundaries were identified in the CC-slab in areas of both active and inactive choroiditis. CC-slab lesion size and shape showed good correlation with lesions identified on indocyanine green angiography. CC-slab lesion area increased with disease activity and decreased with corticosteroid treatment. During active disease, the CC-slab lesion area was larger than both the ONL-slab and fundus autofluorescence lesion areas. Active CC-slab lesions not associated with corresponding abnormal autofluorescence resolved without clinical scarring after treatment. In inactive scars, the areas of retinal and choriocapillaris lesions were similar and did not change over time.
En-face analysis of SS-OCTA choriocapillaris flow voids provide a non-invasive method for the detection of lesions in patients with SC. The presence of lesions in the choriocapillaris in the absence of retinal pigment epithelium and outer retinal abnormalities supports the hypothesis that choriocapillaris is the primary site of pathology in SC, and may be a sensitive early sign of disease activity. We propose a simple grading system of SC lesions based on SS-OCTA and fundus autofluorescence findings. SS-OCTA is a promising non-invasive method for monitoring patients with SC.
使用扫频光学相干断层扫描血管造影（SS-OCTA）和表面成像分析，检查并量化活动性和静止性匐行性脉络膜炎（SC）中的脉络膜毛细血管病变。
前瞻性观察病例系列。
临床诊断为SC的患者。
使用SS-OCTA原型对活动性和静止性匐行性病变在抗炎治疗前后进行纵向成像。分别从OCTA和OCT数据生成脉络膜毛细血管血流的表面图像（CC图像）或外核层结构的表面图像（ONL图像）。
使用半自动MATLAB算法对病变边界和面积进行定性和定量分析。病变还与传统多模态成像进行比较。
对3例患者的6只眼进行了成像。在6只眼中的4只眼中识别并分析了脉络膜病变。在活动性和非活动性脉络膜炎区域的CC图像中均识别出边界清晰的病变。CC图像中的病变大小和形状与吲哚菁绿血管造影中识别出的病变显示出良好的相关性。CC图像中的病变面积随疾病活动度增加而增大，随皮质类固醇治疗而减小。在疾病活动期，CC图像中的病变面积大于ONL图像和眼底自发荧光病变面积。与相应异常自发荧光不相关的活动性CC图像病变在治疗后无临床瘢痕形成而消退。在非活动性瘢痕中，视网膜和脉络膜毛细血管病变面积相似且随时间无变化。
对SS-OCTA脉络膜毛细血管血流缺损进行表面分析，为检测SC患者的病变提供了一种非侵入性方法。在没有视网膜色素上皮和外层视网膜异常的情况下脉络膜毛细血管中存在病变，支持了脉络膜毛细血管是SC病理主要部位的假说，并且可能是疾病活动的敏感早期迹象。我们基于SS-OCTA和眼底自发荧光结果提出了一种简单的SC病变分级系统。SS-OCTA是一种用于监测SC患者的有前景的非侵入性方法。
