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DETECTION OF TYPE 1 CHOROIDAL NEOVASCULAR MEMBRANES USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN TUBERCULAR POSTERIOR UVEITIS

Aggarwal, Kanika, MS*; Agarwal, Aniruddha, MD*; Sharma, Aman, MD; Sharma, Kusum, MD; Gupta, Vishali, MS*for the OCTA Study Group

doi: 10.1097/IAE.0000000000002176
Original Study: PDF Only

Purpose: To study optical coherence tomography angiography (OCTA) and multimodal imaging features of Type 1 inflammatory choroidal neovascularization (CNV) in tubercular serpiginous-like choroiditis and response to anti–vascular endothelial growth factor therapy.

Methods: In this study, multimodal imaging was performed using OCTA, enhanced-depth imaging optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Correlation of OCTA with other imaging modalities in the detection of CNV was performed. The changes in CNV configuration after anti–vascular endothelial growth factor therapy were assessed.

Results: In this study, nine eyes (8 patients; 5 females; mean age: 32.5 ± 11.57 years) with diagnosis of tubercular serpiginous-like choroiditis were included. All the eyes had presence of low-lying pigment epithelial detachments on enhanced-depth imaging optical coherence tomography. Using OCTA, it was possible to detect Type 1 CNV in all eyes. Type 1 CNV networks comprised fine anastomotic network of vessels, some of which had a hairpin loop configuration. After anti–vascular endothelial growth factor therapy, there was a decrease in branching and anastomosis. The visual acuity significantly improved from 0.49 ± 0.26 (20/60 Snellen equivalent) at baseline to 0.26 ± 0.17 (20/36 Snellen equivalent) (P = 0.03) in all eyes.

Conclusion: Type 1 CNV can occur among patients with tubercular serpiginous-like choroiditis, leading to significant visual loss even in the healed stages of the disease. Optical coherence tomography angiography can help in the detection of Type 1 CNV where conventional multimodal imaging, including fluorescein angiography and OCT, fails to make a definitive diagnosis and thereby guide the initiation of anti–vascular endothelial growth factor therapy.

Optical coherence tomography angiography allows for noninvasive detection of Type 1 choroidal neovascular membranes in patients with posterior uveitis in cases where such findings cannot be detected using other techniques such as fundus photography, fluorescein/indocyanine green angiography, and optical coherence tomography. Optical coherence tomography angiography helps in the decision to treat using anti–vascular growth factor agents and can be used to serially detect changes in the choroidal neovascular membrane configuration after therapy.

*Department of Ophthalmology,Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and

Department of Medical Microbiology, Division of Mycobacteriology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Reprint requests: Vishali Gupta, MS, Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India; e-mail: vishalisara@yahoo.co.in

Supported in part by a grant from Department of Biotechnology, India, for the development of Centre of Excellence at the Advanced Eye Centre, PGIMER, Chandigarh.

None of the authors has any financial/conflicting interests to disclose.

The authors alone are responsible for the content and preparation of this manuscript.

© 2018 by Ophthalmic Communications Society, Inc.