Elahi Sina, Gillmann Kevin, Gasc Amel, Jeannin Bruno, Herbort Carl P
Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.
Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland.
J Curr Ophthalmol. 2019 Jan 17;31(2):180-187. doi: 10.1016/j.joco.2018.12.006. eCollection 2019 Jun.
To investigate indocyanine green angiography (ICGA), fluorescein angiography (FA), and enhanced depth imaging optical coherence tomography measured choroidal thickness (EDI-OCT-CT) in the follow-up of inflammatory activity in stromal choroiditis [Vogt-Koyanagi-Harada disease (VKH) and birdshot retinochoroiditis (BRC)] under treatment in order to monitor tapering of therapy or readjustment of therapy in case of subclinical disease recurrence.
Patients with initial onset disease and/or treatment-naive stromal choroiditis (VKH & BRC) at entry, quiet under therapy, and having had a follow-up of at least four years monitored with dual FA and ICGA and EDI-OCT-CT measurements were analyzed retrospectively. ICGA and FA scores and EDI-OCT-CT values were correlated with therapy, and significant changes of each modality were correlated with disease evolution.
Of the 31 VKH and 29 BRC patients seen from 1995 to 2017 in our center, four patients (2 VKH and 2 BRC patients) fulfilled the inclusion criteria. During tapering, two patients (both VKH) showed no significant ICGA, FA, and EDI-OCT-CT changes (mean follow-up time 5.6 years) and allowed for safe tapering. In the other two (BRC) patients (mean follow-up time 6.25 years), a total of seven significant subclinical changes were demonstrated by ICGA alone after therapy modifications due to side-effects or during attempted tapering of therapy, while FA and EDI-OCT-CT remained unchanged.
ICGA was the most sensitive monitoring modality of stromal choroiditis, able to identify subclinical recurrences following change of therapy and inversely treatment responses after readjusted therapy, events otherwise missed by FA and EDI-OCT. ICGA proved efficient for safe therapy tapering or for timely adjustment of therapy in stromal choroiditis when necessary.
研究吲哚菁绿血管造影（ICGA）、荧光素血管造影（FA）和增强深度成像光学相干断层扫描测量的脉络膜厚度（EDI-OCT-CT）在基质性脉络膜炎[伏格特-小柳-原田病（VKH）和匐行性脉络膜视网膜炎（BRC）]治疗期间炎症活动随访中的应用，以便在亚临床疾病复发时监测治疗的减量或调整。
回顾性分析初始发病和/或初治的基质性脉络膜炎（VKH和BRC）患者，这些患者在入组时病情处于缓解期，接受治疗且随访至少四年，期间进行了双FA、ICGA和EDI-OCT-CT测量。ICGA和FA评分以及EDI-OCT-CT值与治疗相关，每种检查方式的显著变化与疾病进展相关。
1995年至2017年在我们中心就诊的31例VKH患者和29例BRC患者中，4例患者（2例VKH和2例BRC患者）符合纳入标准。在治疗减量期间，2例患者（均为VKH）的ICGA、FA和EDI-OCT-CT均无显著变化（平均随访时间5.6年），可以安全地减量。另外2例（BRC）患者（平均随访时间6.25年），在因副作用调整治疗或尝试减量治疗后，仅ICGA共显示出7次显著的亚临床变化，而FA和EDI-OCT-CT保持不变。
ICGA是基质性脉络膜炎最敏感的监测方式，能够识别治疗改变后的亚临床复发以及调整治疗后的反向治疗反应，而这些情况FA和EDI-OCT可能会漏诊。ICGA被证明在基质性脉络膜炎中对于安全地减量治疗或在必要时及时调整治疗是有效的。
