National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Eye (Lond). 2024 Jun;38(9):1742-1747. doi: 10.1038/s41433-024-03012-5. Epub 2024 Mar 12.
To evaluate the utility of ultrawide-field fluorescein angiography (UWFFA) in patients with anterior uveitis by investigating the detection of retinal vascular leakage (RVL) and the subsequent implications on disease diagnosis and management.
STUDY DESIGN/MATERIALS AND METHODS: Patients, who were referred to the National Eye Institute (NEI) for evaluation of anterior uveitis and underwent UWFFA imaging at the initial visit, were included in this study. The electronic medical records of eligible patients were reviewed. The UWFFA images were assessed for severity of retinal vascular leakage, presence of macular leakage, and optic disc leakage by a two-grader system, and intergrader agreement was calculated using the κ-value. Patients with altered diagnoses and management attributable to UWFFA results were noted.
A total of 93 eyes of 63 patients were included in the study. Of 93 eyes, 31 (33.3%) eyes had RVL on UWFFA, with 26 (28.0%) eyes and 5 (5.4%) eyes showing mild and moderate-severe RVL, respectively. Twenty-five (26.9%) eyes showed macular leakage, and 7 (7.5%) eyes showed optic disc leakage. The κ-values ranged from 0.85 - 0.87 indicating excellent intergrader agreement. Of the 31 eyes with RVL, the diagnosis was changed to anterior/intermediate uveitis for 9 (29.0%) eyes and to panuveitis for 4 (12.9%) eyes. Systemic treatment was escalated in 5 patients.
Our results suggest that UWFFA imaging is useful in detecting subclinical posterior involvement in patients with anterior uveitis. Moreover, UWFFA results in altered diagnosis and treatment approaches in a portion of patients.
通过研究视网膜血管渗漏（RVL）的检测及其对疾病诊断和管理的后续影响，评估超广角荧光素血管造影（UWFFA）在前葡萄膜炎患者中的应用价值。
研究设计/材料和方法：本研究纳入了因前葡萄膜炎就诊于国立眼科研究所（NEI）并在初次就诊时接受 UWFFA 成像检查的患者。回顾了符合条件的患者的电子病历。使用两级评分系统评估 UWFFA 图像的视网膜血管渗漏严重程度、是否存在黄斑渗漏和视盘渗漏，并使用κ 值计算分级者间的一致性。记录了因 UWFFA 结果而改变诊断和治疗的患者。
本研究共纳入了 63 例患者的 93 只眼。93 只眼中，31 只眼（33.3%）在 UWFFA 上有 RVL，其中 26 只眼（28.0%）和 5 只眼（5.4%）分别显示轻度和中重度 RVL。25 只眼（26.9%）有黄斑渗漏，7 只眼（7.5%）有视盘渗漏。κ 值范围为 0.85-0.87，表明分级者间具有极好的一致性。31 只 RVL 眼中，9 只眼（29.0%）的诊断改为前/中间葡萄膜炎，4 只眼（12.9%）的诊断改为全葡萄膜炎。5 例患者的全身治疗升级。
我们的结果表明，UWFFA 成像有助于检测前葡萄膜炎患者的亚临床后节受累。此外，UWFFA 结果改变了一部分患者的诊断和治疗方法。
