Assessment of Vascular Change Using Swept-Source Optical Coherence Tomography Angiography: A New Theory Explains Central Visual Loss in Behcet's Disease.

Thanapong Somkijrungroj,Sasivarin Luangpitakchumpol,Peranut Chotcomwongse,Korrawan Jaisuekul,Wijak Kongwattananon,Sritatath Vongkulsiri

doi:10.1155/2017/2180723

Abstract

Objective To evaluate retinal vascular structural change in ocular Behcet's using optical coherence tomography angiography (OCTA) and fluorescein angiography (FA). Methods An analytic cross-sectional study of 37 eyes of 21 Behcet's uveitic patients was performed. Foveal retinal thickness (FRT), perifoveal hypoperfusion areas in superficial capillary plexus (SCP), and deep capillary plexus (DCP) were measured with swept-source optical coherence tomography and OCTA. FA images were used for assessing the vascular features and correlation. Results Twenty-one patients were enrolled (52.4% males). The average age at onset was 36.7 ± 12.93 years. The median of disease duration was 5 years (1–25). FRT was 118.1 ± 52.35 μm, which correlated with visual acuity (95% CI −60.47, −13.92). Using OCTA, the area of hypoperfusion in SCP (0.47 ± 0.17 mm2) was smaller than that in DCP (1.94 ± 3.87 mm2) (p < 0.001). Superficial to deep capillary plexus nonperfusion (SCP : DCP) ratio was 0.57 ± 0.27 which had the positive coefficient correlation with visual acuity (95% CI −0.644, −0.015). Conclusions OCTA is an alternative noninvasive method to monitor macular ischemia in Behcet. Behcet's uveitis affects DCP more than SCP. Decreasing SCP : DCP ratio and decrease FRT correlates with poor visual acuity. Macular ischemia and DCP loss can be found early and can explain vision loss in Behcet.

Highlights

Behcet’s disease, firstly described in 1937, is a chronic nongranulomatous occlusive vasculitis disease characterized by recurrent oral and genital ulcerations as well as ocular lesions
Ocular examination consisted of Snellen visual acuity converted to logarithm of minimum angle of resolution equivalent units, intraocular pressure (IOP) by air-puff tonometry, OCT, optical coherence tomography angiography (OCTA), and Fluorescein angiography (FA) was done
We found moderate correlation between Foveal retinal thickness (FRT) and visual acuity (R2 = 0 243, p = 0 003, 95% CI −60.47, −13.92)

Summary

Introduction

Behcet’s disease, firstly described in 1937, is a chronic nongranulomatous occlusive vasculitis disease characterized by recurrent oral and genital ulcerations as well as ocular lesions. It can affect multiple organs including the heart, joints, and central nervous system. About 50% of the patients with Behcet’s disease have ocular involvement [1]. Fluorescein angiography (FA) has been considered the gold standard to demonstrate the inflammatory activity in Behcet’s uveitis. It is unable to demonstrate superficial and deep capillary vasculature separately. FA is a relatively invasive investigation and has a limitation in some patients due to dye usage

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Results

Conclusion