Choroid vascularity index as a parameter for chronicity of Fuchs’ uveitis syndrome

Ağın A., Kadayıfçılar S., Sönmez H.E., Baytaroğlu A., Demir S., Sağ E., Özen S., Eldem B.

ObjectiveThe aim of this study was to conduct a detailed ophthalmological examination in children with systemic lupus erythematosus (jSLE), including choroidal thickness (ChT), choroidal vascularity index (CVI) and peripapillary retinal nerve fiber layer (RNFL).MethodsThe study included all jSLE patients ( n = 21) diagnosed according to the Systemic Lupus International Collaborating Clinics classification criteria between January 2017 and April 2017, and an age- and gender-matched control group ( n = 21). The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used to assess disease activity. After routine eye examinations, ChT at five points (750 µ and 1500 µ from the center of the fovea both in the temporal and nasal quadrants and under the fovea), total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), CVI and RNFL thickness at the optic disc were evaluated.ResultsOne patient had active ocular involvement in the form of episcleritis. Another patient had corticosteroid-induced cataract. The median age of the patients was 16 years (6-19 years). ChT at five points, TCA, LA and SA were found to be higher in patients with jSLE, whereas RNFL thickness and CVI were similar to those of the healthy control individuals. No correlation was determined between optical coherence tomography findings, SLEDAI and the immunological parameters (antinuclear antibodies, anti-double-stranded DNA, complements 3 and 4, extracted nuclear antigen antibody, antiphospholipid antibody). Intraretinal and subretinal fluid was not present in any of the patients.ConclusionThe choroid was thicker in patients with jSLE than in the control group. The study results suggest that jSLE may affect the choroid. Ophthalmological evaluation is important in SLE patients, even in the absence of relevant complaints.

Tan R., Agrawal R., Taduru S., Gupta A., Vupparaboina K., Chhablani J.

To evaluate structural changes in the choroid of patients with retinitis pigmentosa (RP) using swept-source optical coherence tomography (OCT) scans.A prospective study was conducted comparing 35 eyes of 35 patients with RP and 26 eyes of 26 normal patients. OCT images of the choroid were binarized into luminal and stromal areas to derive choroidal vascularity index (CVI). Subfoveal choroidal thickness (CT) was also measured and compared.There was a significant decrease in the mean CVI among eyes with RP as compared to normal eyes (56.91 ± 1.43% vs. 59.47 ± 1.55%; P < .0001). Mean subfoveal CT was significantly greater in eyes with RP as compared to normal eyes (262.82 μm ± 69.69 μm vs. 194.65 μm ± 23.55 μm; P < .0001).Patients with RP showed a significant reduction in CVI and an increase in CT as compared to normal eyes. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:191-197.].

Agarwal A., Agrawal R., Khandelwal N., Invernizzi A., Aggarwal K., Sharma A., Singh R., Bansal R., Sharma K., Singh N., Gupta V.

To assess choroidal vascular changes among patients with tubercular multifocal serpiginoid choroiditis (TB MSC) using previously validated techniques.Patients with TB MSC (n = 18) and healthy controls (n = 30) underwent enhanced-depth imaging optical coherence tomography (EDI-OCT) imaging. Using previously validated algorithm of image binarization, EDI-OCT scans were segmented to derive total choroidal area, luminal area, stromal area, and choroidal vascularity index (CVI).There was a statistically significant difference in the CVI between controls (66.90 ± 1.77%) and TB MSC patients (65.46 ± 2.53%; p < 0.001). There was significant reduction in CVI at follow-up (3 months) (63.77 ± 3.91%; p = 0.05). The choroidal thickness was higher in TB MSC compared to controls (278.90 ± 57.84 µm versus 329.33 ± 27.69 µm; p = 0.001).CVI provides insight into structural changes in choroid in TB MSC. During the active disease, there is relative decrease in choroidal vascularity. As the lesions heal, choriocapillaris atrophy occurs with remodeling of choroid.

Ratra D., Tan R., Jaishankar D., Khandelwal N., Gupta A., Chhablani J., Agrawal R.

To evaluate structural changes in the choroid of patients with Stargardt disease using swept source optical coherence tomography scans.A retrospective comparison cohort study was conducted on 39 patients with Stargardt disease, and on 25 age and gender matched-healthy controls. Subfoveal choroidal thickness (SFCT) was computed from the swept source optical coherence tomography machine, and the scans were binarized into luminal area and stromal areas, which were then used to derive choroidal vascularity index (CVI). Choroidal vascularity index and SFCT were analyzed independently using linear mixed effects model.There was no significant difference in SFCT between the 2 groups (347.20 ± 13.61 μm in Stargardt disease vs. 333.09 ± 18.96 μm in the control group, P = 0.548). There was a significant decrease in the CVI among eyes with Stargardt disease as compared with the normal eyes (62.51 ± 0.25% vs. 65.45 ± 0.29%, P < 0.001). There was a negative association between visual acuity and CVI (correlation coefficient = -0.75, P < 0.001) and a positive association between visual acuity and SFCT (correlation coefficient = 0.21, P = 0.035).Choroidal vascularity index appears to be a more robust tool compared with SFCT for choroidal changes in Stargardt disease. Choroidal vascularity index can possibly be used as a surrogate marker for disease monitoring. A decrease in CVI was associated with a decrease in visual function in eyes with Stargardt disease.

Koh L.H., Agrawal R., Khandelwal N., Sai Charan L., Chhablani J.

To assess the choroidal vascular changes using choroidal vascularity index (CVI) in patients with age-related macular degeneration (AMD) compared to controls.Enhanced depth imaging (EDI) optical coherence tomography (OCT) scans of 64 patients with unilateral or bilateral AMD were obtained. Images with a poorly demarcated choroidal-scleral interface (CSI) were excluded from the analysis. Foveal scans of 63 AMD eyes and 35 'normal fellow' eyes were analysed. Images of 30 eyes from 18 age-matched healthy subjects were included as controls. Choroidal vascularity index (CVI) was derived from binarization of EDI OCT images, using fiji software.The mean age was 56.50 ± 5.50 years for AMD patients and 52.25 ± 6.75 years for controls. All patients were treatment naïve. Subfoveal choroidal thickness (SFCT) in AMD, 'normal fellow' eyes and controls was 314.02 ± 78.80 μm, 300.88 ± 53.85 μm and 278.5 ± 65.31 μm, respectively. Choroidal vascularity index (CVI) in AMD, 'normal fellow' eyes and controls was 64.04 ± 2.43%, 64.66 ± 2.25% and 66.07 ± 1.72%, respectively. Choroidal vascularity index (CVI) of both AMD and 'normal fellow' eyes was significantly lower compared to controls (p < 0.0001 and p = 0.007). The SFCT of AMD eye was not found to be significantly different from 'normal fellow eyes' (p = 0.45).There was no statistical difference in SFCT, but CVI was significantly lower in patients with AMD. Choroidal vascularity index (CVI) was also lower in 'normal fellow' AMD eyes as compared to controls. This suggests possible reduction in choroidal vascularity in eyes with AMD and also to a certain extent in the 'normal fellow' eyes without phenotypical manifestations and may suggest underlying choroidal morphological change leading to wet AMD.

Balci O., Ozsutcu M.

Purpose.We aimed to investigate retinal and choroidal thickness in the eyes of patients with Fuchs’ uveitis syndrome (FUS).Methods.Fifteen patients with unilateral FUS and 20 healthy control subjects were enrolled. Spectral domain optical coherence tomography (Spectralis HRA+OCT, 870 nm; Heidelberg Engineering, Heidelberg, Germany) was used to obtain retinal and choroidal thickness measurements. The retinal nerve fiber layer (RNFL) thickness, macular thickness, and choroidal thickness of the eyes with FUS were compared with the unaffected eye and the eyes of healthy control subjects.Results.The mean choroidal thickness at fovea and at each point within the horizontal nasal and temporal quadrants at 500 μm intervals to a distance of 1500 µm from the foveal center was significantly thinner in the affected eye of FUS patients compared with the unaffected eye of FUS patients or the eyes of healthy control subjects. However, there were no significant differences in RNFL or macular thickness between groups.Conclusions.Affected eyes in patients with FUS tend to have thinner choroids as compared to eyes of unaffected fellow eyes and healthy individuals, which might be a result of the chronic inflammation associated with the disease.

Wei X., Ting D.S., Ng W.Y., Khandelwal N., Agrawal R., Cheung C.M.

To evaluate choroidal structural changes in exudative age-related macular degeneration (AMD) using choroidal vascularity index computed from image binarization on spectral domain optical coherence tomography with enhanced depth imaging.This prospective case series included 42 consecutive patients with unilateral exudative AMD. Choroidal images were segmented into luminal area and stromal area. Choroidal vascularity index was defined as the ratio of luminal area to total choroid area. Mean choroidal vascularity index and mean choroidal thickness between study and fellow eyes of the same patient with dry AMD were compared using Student's t-test.There was a significantly lower choroidal vascularity index in eyes with exudative AMD (60.14 ± 4.55 vs. 62.75 ± 4.82, P < 0.01). Luminal area (P < 0.01) was decreased in eyes with exudative AMD but there was no significant difference in total choroid area (P = 0.05) and choroidal thickness (P = 0.93) between study and fellow eyes.Eyes with exudative AMD demonstrated reduced choroidal vascularity index but insignificant differences in choroidal thickness compared with their fellow eyes. Choroidal vascularity index may be a potential noninvasive tool for studying structural changes in choroid and monitoring choroidal disease in exudative AMD.

Cerquaglia A., Iaccheri B., Fiore T., Lupidi M., Torroni G., Fruttini D., Giacalone C., Cagini C.

To perform a quantitative analysis of choroidal thickness in patients with Fuchs Uveitis Syndrome (FUS) using enhanced depth imaging optical coherence tomography (EDI-OCT). All patients underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp biomicroscopy, applanation tonometry, axial length measurements with a swept-source biometer (IOLMaster 700, Carl Zeiss Medic AG, Jena, Germany) and macular 30° linear EDI- B-scan SD-OCT section (Spectralis HRAII+OCT, Heidelberg Engineering, Heidelberg, Germany) in both eyes. Analysis of choroidal thickness was performed at three different locations: subfoveally, 750 μm nasally, and 750 μm temporally to the fovea. Patients having received any surgery or intravitreal injections in the last 12 months and with axial length variance ≥ 1 mm between both eyes were excluded. Sixteen eyes of eight consecutive patients with unilateral FUS were included. Segmented analysis of the choroid, separately considering Haller’s layer and Sattler’s–choriocapillaris layers, showed statistically significant lower values (p < 0.05) in affected eyes (FEs) compared to fellow eyes (NFEs). In NFEs, total choroidal thickness mean values ranged from 305.62 ± 92.96 μm to 347.50 ± 91.55 μm; in FEs those values were significantly lower (p < 0.05), ranging from 232.62 ± 89.33 μm to 255.62 ± 89.33 μm. Diffuse and full-thickness choroidal thinning in FEs was observed. Considering the absence of significant axial length differences between FEs and NFEs in our patient series, these data seem to suggest that the full-thickness choroidal thinning in FEs may be due to the inflammatory process. In that way, FUS might be regarded as an inflammatory condition involving the whole uveal tunic, even the posterior part of it, definitively supplanting the early definition of “heterochromic iridociclytis”.

Alfawaz A.M., Holland G.N., Yu F., Margolis M.S., Giaconi J.A., Aldave A.J.

To investigate a possible effect of intraocular inflammation on corneal endothelium by describing corneal endothelial cell density (ECD) and morphologic variables in eyes with anterior uveitis, and to investigate factors that may influence these findings.Cross-sectional, observational study. Observers were not masked.Volunteers with histories of unilateral or bilateral anterior segment inflammation (anterior, intermediate, or panuveitis); included were 52 patients (84 eyes with uveitis).Endothelial cell density and morphologic variables of both eyes of all study participants were determined by specular microscopy; central corneal thickness was determined by ultrasound pachymetry.Central corneal ECD, coefficient of variability, percentage hexagonality, and central corneal thickness.Central ECD was lower among eyes that had undergone cataract or glaucoma surgery or both (n = 28; P = 0.0004). After exclusion of eyes with surgery, variables for eyes with uveitis (n = 56) were compared with 2 historical populations of normal, age-matched controls and with contralateral eyes in individuals with unilateral uveitis. Central ECD was lower in eyes with uveitis than in control eyes for all age groups (P ≤ 0.01 for four of six 10-year age intervals compared with the primary control group). Among patients with unilateral uveitis who had not undergone surgery in either eye (n = 12), central ECD was lower in eyes with uveitis (2324 cells/mm(2) [range, 1543-3289 cells/mm(2)]) than in contralateral eyes (2812.5 cells/mm(2) [range, 1887-3546 cells/mm(2)]; P = 0.0005), and percentage hexagonality was lower in eyes with uveitis (54% [range, 33%-66%]) than in contralateral eyes (58.5% [range, 52%-82%]; P = 0.004). There was no significant difference in central corneal thickness between eyes with and without uveitis (P = 0.27). No eyes had clinically apparent central corneal edema. Relationships remained unchanged after exclusion of eyes with herpetic anterior uveitis. Host and disease-related characteristics were evaluated as risk factors for variations in outcome measures. Central ECD was correlated to the duration of active uveitis (r = -0.41; P < 0.0001), maximum intraocular pressure during the course of disease (r = -0.40; P = 0.0002), and maximum laser flare photometry value (r = -0.26; P = 0.020).Observed relationships suggest that anterior segment inflammation adversely affects the corneal endothelium. Longitudinal studies are warranted to determine whether long-standing anterior uveitis increases risk of endothelial dysfunction, especially in the setting of intraocular surgery.

Agrawal R., Li L.K., Nakhate V., Khandelwal N., Mahendradas P.

We assessed the application of the choroidal vascularity index (CVI) in the follow-up of Vogt-Koyanagi-Harada disease (VKH) patients derived from image binarization of enhanced depth imaging optical coherence tomography (EDI-OCT) images with Fiji software. Our secondary objective was to derive the retinochoroidal vascularity index based on en face fundus fluorescein and indocyanine green angiography (FFA and ICGA).In this retrospective cohort study, EDI-OCT scans of 18 eyes of 9 patients with VKH were obtained at baseline within 2 weeks of acute presentation, and again at 6 to 12 months. Images with poor quality were excluded. Choroidal thickness (CT) and CVI were analyzed and compared to 13 eyes of 13 healthy controls. En face FFA and ICGA obtained from 12 eyes of 7 patients were segmented to derive retinochoroidal vascularity index.There was no statistical difference in age or sex between the study group and controls. Choroidal thickness of patients with VKH was 359.23 ± 57.63 μm at baseline, compared to 274.09 ± 56.98 μm in controls (P = 0.003). Follow-up CT in VKH patients was 282.62 ± 42.51 μm, which was significantly decreased from baseline (P = 0.0001). Choroidal vascularity index in VKH patients was 70.03 ± 1.93% at baseline, compared to 64.63 ± 1.92% in controls (P < 0.001). Choroidal vascularity index was 66.94 ± 1.82% at follow-up, significantly reduced from baseline (P < 0.0001). Fundus fluorescein angiography and ICGA retinochoroidal vascularity indices at baseline were 70.67 ± 2.65% and 66.42 ± 2.16%, respectively.In this small series of VKH patients, EDI-OCT-derived CVI had a statistically significant reduction over time, similar to CT. We propose that OCT, FFA, and ICGA-derived vascularity indices may be potential novel supportive tools in monitoring disease progression in VKH.Choroidal vascularity index can be used potentially to study and analyze the structural changes in choroid. It can be a useful tool to explain the changes in the CT in different retinochoroidal disorders. Choroidal vascularity index also can be used for longitudinal follow-up in patients with VKH disease and other inflammatory disease involving the choroid.

Tan K., Laude A., Yip V., Loo E., Wong E.P., Agrawal R.

To propose the use of choroidal vascularity index (CVI) as a novel tool to assess vascular status of the choroid using image binarization of enhanced depth imaging (EDI) optical coherence tomography (OCT) scans in diabetes mellitus (DM).A prospective cross-sectional study was performed at a tertiary referral eye care centre in Singapore. Age and gender matched EDI-OCT scans of 38 eyes of 19 patients with DM were compared with eyes of healthy controls (n = 19). The choroidal images were binarized into luminal areas (LA) and stromal areas (SA). Choroidal vascularity index (CVI) was defined as the proportion of LA to total circumscribed subfoveal choroid area (TCA). Mean choroidal thickness, mean retinal thickness and mean CVI between patients and controls were compared using student's t-test.There were no significant differences in TCA (p = 0.78), LA (p = 0.90), SA (p = 0.33), average choroidal (p = 0.40) or retinal thickness (p = 0.70) between patients with DM and controls. However, there was a significantly lower CVI in patients with DM as compared to controls (65.10 ± 0.20 versus 67.20 ± 0.16, p < 0.0001).Eyes of patients with DM showed decreased CVI with no corresponding change in choroidal thickness. Image binarization may be potentially useful as a tool to assess choroidal structures and vasculature.

Agrawal R., Chhablani J., Tan K., Shah S., Sarvaiya C., Banker A.

To evaluate choroidal vascularity index (CVI) in eyes with central serous chorioretinopathy (CSC) using an image binarization tool on enhanced depth imaging using spectral domain optical coherence tomography scans.In this retrospective cohort study, enhanced depth imaging optical coherence tomography scans of both eyes of patients with CSC were taken at baseline; they were segmented and compared with enhanced depth imaging optical coherence tomography scans of fellow eyes without CSC as well as age-matched healthy subjects. Subfoveal choroidal area (1,500 μm) was segmented into luminal area and stromal area using image binarization. Choroidal vascularity index was defined as the proportion of luminal area to the total circumscribed subfoveal choroidal area.Eyes with acute CSC (32 eyes) had significantly higher CVI compared with their fellow eyes (27 eyes) (P < 0.0001), 19 eyes with resolved CSC (P < 0.0001) and with 30 eyes of age-matched healthy eyes (P < 0.0001). Fellow eyes of subjects with acute CSC also had significantly higher CVI compared with eyes with resolved CSC (P < 0.0001) and age-matched healthy eyes (P < 0.0001).Increased CVI suggests increased vascular component compared with the stromal component in acute CSC. Increased CVI was noted in fellow eye of the subjects with acute CSC in comparison with age-matched healthy subjects. The CVI could be a useful index for early diagnosis of CSC and to assess the treatment response after laser photocoagulation or photodynamic therapy.

Kardes E., Sezgin Akçay B.I., Unlu C., Ergin A.

Agrawal R., Salman M., Tan K., Karampelas M., Sim D.A., Keane P.A., Pavesio C.

Purpose To compute choroidal vascularity index (CVI) using an image binarization tool on enhanced depth imaging (EDI)-optical coherence tomography (OCT) scans as a non-invasive optical tool to monitor progression in panuveitis and to investigate the utility of volumetric data from EDI-OCT scans using custom image analysis software. Materials and Methods In this retrospective cohort study, segmented EDI-OCT scans of both eyes in 19 patients with panuveitis were taken at baseline and at 3-month follow-up and were compared with EDI-OCT scans of normal eyes. Subfoveal choroidal area was segmented into luminal (LA) and stromal interstitial area (SA). Choroidal vascularity index (CVI) was defined as the proportion of LA to the total circumscribed subfoveal choroidal area (TCA). Results The mean choroidal thickness was 265.5±100.1μm at baseline and 278.4±102.6μm at 3 months follow up (p = 0.06). There was no statistically significant difference in TCA between study and control eyes (p = 0.08). CVI in the control group was 66.9±1.5% at baseline and 66.4±1.5% at follow up. CVI was 74.1±4.7% at baseline and 69.4±4.8% at 3 months follow up for uveitic eyes (p

Szepessy Z., Tóth G., Barsi Á., Kránitz K., Nagy Z.Z.

To evaluate the differences in the biometric parameters of the anterior segment in Fuchs' uveitis syndrome (FUS).30 eyes of 15 consecutive patients with unilateral FUS were examined. Anterior segment parameters were measured by rotating Scheimpflug imaging camera. Central endothelial cell count was measured by noncontact specular microscopy.The central cornea was thinner (p < 0.001), the iridocorneal angle was significantly larger (p < 0.010), anterior chamber depth was deeper in the eyes with FUS (p < 0.006). The iris bowing was different between the affected eye and the healthy eye. The mean endothelial cell density of eyes with FUS was significantly lower than control eyes (p < 0.001).Scheimpflug imaging method is a useful tool to analyze the anterior segment parameters in FUS. Endothelial cell loss, as well as decreased percentage of endothelial hexagonal cells, is obtained by noncontact specular microscopy in patients with FUS.

Kumar M., Khuu S.K., Trinh M., Madigan M.C., Agrawal R., Rojas-Carabali W., Nivison-Smith L.

Abstract Choroidal vascularity index (CVI) has been extensively used to assess choroidal health in posterior eye disease; however, interpretation is hindered by conflicting evidence on effect of normal physiological factors on CVI. Thus, this review aimed to derive a normative value for CVI and understand its relationship with various normal ocular/image-based factors. Studies were screened for eligibility, defined as eyes with normal ocular parameters (refractive error (RxE) < ± 6 DS, intraocular pressure (IOP < 21 mmHg) and no posterior segment disease and 98 studies were included. Pooled weighted average of subfoveal CVI extracted from healthy eyes (n = 5332 eyes) was 66.50% [CI 65.67–67.32]. Secondary stratifications (time of scan, device wavelength, imaging mode, region of interest, systemic factors) and meta regression (age, RxE and IOP) were insignificant on CVI (p = 0.579–0.872), however Best corrected visual acuity showed positive correlation (p = 0.037). Unaltered, narrow confidence interval in sensitivity analysis, complemented by non-significant publication bias indicated robustness of the synthesised data. These results provide the highest-level evidence in hierarchy of the first normative subfoveal CVI value synthesised from literature and that it is not influenced by most person, eye and imaging factors in healthy eyes.

Yesilirmak N., Kurt B., Aktas A., Behar-Cohen F., Bourges J.

To compare the choroidal thickness (CT) and choroidal vascularity index (CVI) values in ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls.

Evereklioglu C., Polat O.A., Sevim D.G., Gahramanov K., Sener H., Sonmez H.K., Arda H., Arslantas E.E., Horozoglu F.

To investigate changes in the choroid using the choroidal vascularity index (CVI) and choroidal thickness (ChT) in patients with ocular (OBD) and non-ocular Behçet disease (non-ocular BD).Sixty-eight OBD patients, 40 non-ocular BD patients, and 40 healthy control subjects were included. ChT was measured using optical coherence tomography (OCT) in enhanced-depth imaging (EDI) mode (EDI-OCT; sub-foveal ChT at 1000 μm, nasal ChT at 1000 μm temporal ChT). The CVI value (%) was calculated by dividing the luminal area by the sub-foveal total choroidal area.The mean sub-foveal ChT (297 ± 68 µm), nasal ChT (261 ± 66 µm), and temporal ChT (272 ± 68 µm) in eyes with OBD and the mean sub-foveal ChT (286 ± 31 µm), nasal ChT (266 ± 29 µm), and temporal ChT (269 ± 32 µm) in eyes with non-ocular BD were significantly decreased compared with those regions in healthy control subjects (333 ± 69, 301 ± 75, and 312 ± 70 µm, respectively). Additional subgroup analysis was performed for active OBD, inactive OBD, non-ocular BD, and the control group, and in pairwise comparisons, the CVI value was significantly decreased in both active (64.3 ± 3.1) and inactive OBD groups (64.2 ± 4.5) compared with healthy control subjects (67.2 ± 3.6; p = 0.026 and p < 0.001, respectively). There was no significant difference between non-ocular BD (65.9 ± 3.4) and control subjects (67.2 ± 3.6) for CVI measurements (p > 0.05).Decreased CVI values in OBD suggest that uveitis affects the choroidal vasculature and that perfusion is affected by uveitis, whereas systemic inflammation in non-ocular BD does not affect them. In addition, the choroid in uveitis is affected by the chronicity of the disease rather than disease activity. ChT measurements and CVI values may be a novel and robust prognosticating biomarker to evaluate choroidal vasculature and to monitor disease progression in OBD patients because EDI-OCT is a non-invasive imaging modality. However, CVI does not seem to be a biomarker for monitoring of disease activity or treatment efficacy.

Agrawal R., Wei X., Loh N.C., Boon J., Bong J.E., Choo S.S., Chua C.H., Rojas-Carabali W., Lee B.

Abstract Objectives To investigate longitudinal changes in choroidal vascularity index (CVI) in uveitis patients with active inflammation at baseline, and at six months. Methods This prospective comparative study included 49 eyes of 49 patients with anterior, intermediate, posterior or panuveitis, and 49 eyes of 49 healthy controls. Uveitis patients were recruited at baseline with active inflammation. Clinical data and multimodal imaging including optical coherence tomography were obtained at baseline and six months. Both two-dimensional (2D) subfoveal CVI and three-dimensional (3D) macular CVI were measured using previously published algorithms. Comparison between uveitis and control group as well as between baseline visit and 6 months visit in the uveitis group were performed using ANCOVA model. Results At baseline, 2D CVI was lower in the uveitis group (62.4% vs 63.8%, p = 0.007) and 3D CVI also showed a lower trend in the uveitis group (62.0% vs 62.8%, p = 0.109) compared to that of healthy subjects. Within the uveitis group, both 2D and 3D CVI were higher at 6 months compared to baseline, but both were not significant (p = 0.055 and 0.177, respectively). Uveitis patients who were still clinically active at 6 months had lower 2D and 3D CVI at baseline compared to those who were clinically quiescent at 6 months (p = 0.027 and p = 0.008, respectively). Conclusions Changes in CVI are correlated with the diagnosis and prognosis of uveitis patients. Lower CVI values at baseline were associated with persistent inflammation after 6 months of follow-up. Thus, CVI may be a useful outcome measure in uveitis management and clinical trials.

Kianersi F., Mortazavi S.A., Peyman A., Rahimi F., Pourazizi M.

Abstract: PURPOSE: The aim of this study was to determine ultrasound biomicroscopic findings in patients with Fuchs uveitis syndrome (FUS). METHODS: This cross-sectional, contralateral comparative eye study was conducted on patients with unilateral FUS. Both eyes of each patient underwent ultrasound biomicroscopy (UBM) imaging at the 12, 3, 6, and 9-o’clock radial meridians. Ultrasonographic data were collected, including the thickness (mm) of the ciliary body (CB), CB with ciliary processes, and iris thickness at 0.8 mm from the iris root, mid-iris, and iris tip. RESULTS: We enrolled 36 eyes from 18 patients with unilateral FUS, including 10 (55.6%) females, with a mean age of 38.44 ± 9.2 years. The average thickness of CB (P < 0.001), 0.8 mm from the iris root (P = 0.003), mid-iris (P < 0.001), and the iris tip (P < 0.001) was thinner in the affected eyes compared to the fellow eyes of the patients. Analysis of variance analysis showed that differences among all quadrants were not significant in both groups (P > 0.05). CONCLUSION: This study showed that CB and iris thickness were significantly thinner in the affected eyes compared to the fellow eyes of patients with FUS, as assessed using the UBM technique.

Evereklioglu C., Er Arslantas E., Sener H., Akkul Z., Gahramanov K., Gulmez Sevim D., Polat O.A., Horozoglu F.

Abstract Objective To evaluate the effect of adalimumab (ADA) on choroidal thickness (ChT) and choroidal vascularity index (CVI) in eyes with non-infectious uveitis (NIU). Methods Thirty-seven eyes with NIU including Behçet disease (BD), sarcoidosis, ankylosing spondylitis (AS), juvenile idiopathic arthritis and idiopathic arthritis, 38 eyes of non-uveitic (NU) patients including BD, AS and rheumatoid arthritis, and 40 healthy control eyes were included. ADA was used for anti-TNF-naive adult (80 mg) or paediatric (40 mg) patients with refractory NIU, then 40 mg every 2-week (20 mg in children<30 kg) with controls at weeks 1, 4, 12, and 24. Images were used to measure central, nasal, and temporal ChT, and the luminal area (LA), stromal area, and total choroidal area (TCA) were analysed using enhanced-depth imaging optical coherence tomography (EDI-OCT) by ImageJ software. The CVI was then calculated as the ratio of LA to TCA. Results Mean ages were similar between the groups. Mean (SE) subfoveal ChT measurements for each location were also similar (for each, p > 0.05). However, calculated CVI values in eyes with NIU (0.63 ± 0.007) were significantly (p < 0.001) lower than NU eyes (0.66 ± 0.006) and controls (0.70 ± 0.007) (p < 0.001). Moreover, CVI was significantly lower in NU eyes compared to controls (p < 0.001). There were no significant CVI changes between the consecutive visits after ADA therapy in eyes with NIU (for each, p > 0.05). Conclusions Decreased CVI in NIU and NU eyes indicates that systemic inflammation affects the choroidal vasculature and perfusion both in the presence and absence of ocular involvement. Although CVI may be used as a possible novel tool in monitoring ocular involvement and progression of NIU, CVI does not seem to be a biomarker for treatment monitoring in NIU.

Evereklioglu C., Arslantas E.E., Sener H., Akkul Z., Gahramanov K., Sevim D.G., POLAT O.A., Horozoglu F.

Abstract Objective To evaluate the effect of adalimumab (ADA) on choroidal thickness (ChT) and choroidal vascularity index (CVI) in eyes with non-infectious uveitis (NIU). Methods Thirty-seven eyes with NIU, 38 eyes of non-uveitic (NU) patients, and 40 control eyes were included. ADA was used for anti-TNF-naive adult (80mg) or pediatric (40mg) patients with refractory NIU, then 40mg every 2-week (20mg in children < 30kg) with controls at weeks 1, 4, 12, and 24. Images were used to measure central, nasal, and temporal ChT, and the luminal area (LA), stromal area (SA), and total choroidal area (TCA) were analysed using enhanced-depth imaging optical coherence tomography (EDI-OCT) by ImageJ software. The CVI was then calculated as the ratio of LA to TCA. Results Mean ages were similar between the groups. Mean (SE) subfoveal ChT measurements for each location were also similar (for each, p > 0.05). However, calculated CVI values in eyes with NIU (0.63 ± 0.007) were significantly (p < 0.001) lower than NU eyes (0.66 ± 0.006) and controls (0.70 ± 0.007) (p < 0.001). Moreover, CVI was significantly lower in NU eyes compared to controls (p < 0.001). There were no significant CVI changes between the consecutive visits after ADA therapy in eyes with NIU (for each, p > 0.05). Conclusions Decreased CVI in NIU and NU eyes indicates that systemic inflammation affects the choroidal vasculature and perfusion both in the presence and absence of ocular involvement. Although CVI may be used as a possible novel tool in monitoring ocular involvement and progression of NIU, CVI does not seem to be a biomarker for treatment monitoring in NIU.

Balci A.S., Pehlivanoglu S., Basarir B., Altan C.

The assessment of retinal and choroidal changes in eyes with unilateral Fuchs uveitis syndrome (FUS) with the fellow eye and healthy control group. Thirty-nine unilateral FUS patients and 42 healthy control subjects were enrolled. Spectralis domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering GmbH, Heidelberg, Germany) was used to evaluate retinal and choroidal structures. Retinal and choroidal thicknesses were recorded from OCT images. Choroidal images were binarized to calculate choroidal vascularity index (CVI) with ImageJ 1.52 s (National Institutes of Health, Bethesda, MD, USA) program. CVI was found to be significantly lower in the FUS group compared to the fellow eyes and healthy control groups (p = 0.039 and p = 0.046, respectively). There was no significant difference in central choroidal thickness in the FUS group compared to the fellow eyes and control groups (p = 0.552 and p = 0.321, respectively). There was no statistically significant difference between the 3 groups in terms of macular thickness in all quadrants (p > 0.05 for all quadrants). Affected eyes tend to decrease in CVI, while there is no difference in retinal and central choroidal thicknesses in patients with FUS compared to eyes of other unaffected eyes and healthy individuals. It may be because the chronic inflammation associated with the disease affects the vascular structure of the choroid.

Zhou F., Li Y., Guo X., Shi X., Wu K., Zheng J., Li X., Wu J., Liu R., Dai M., Huang X., Hou F., Lin D., Wang Y.

PurposeTo investigate the deficits in contrast sensitivity in patients with Fuchs uveitis syndrome (FUS) and to explore the potential relationship between contrast sensitivity and ocular structure.MethodsIn this prospective study, 25 patients with FUS and 30 healthy volunteers were recruited. Eyes were divided into three groups: FUS-affected eyes (AE), fellow eyes (FE), and healthy eyes. The contrast sensitivity function (CSF) of all participants was evaluated using the quick CSF (qCSF) method. Fundus photographs were collected for the analysis of refractive media, and vascular density (VD) was assessed using optical coherence tomography angiography (OCTA). Data were analyzed and compared using the generalized estimating equation (GEE).ResultsThe CSF of AE was significantly lower than that of FE and controls, while no significant difference was observed between FE and controls. Contrast sensitivity was negatively correlated with the grade of haze. No significant correlation was found between visual function and VDs in FUS eyes.ConclusionsWe found that the CSF of FUS-affected eyes was significantly reduced, and the visual impairment was predominantly caused by the refractive media turbidity.

Ağın A., Kadayıfçılar S., Baytaroğlu A., Deliktaş Ö., Demir S., Sağ E., Bilginer Y., Karakaya J., Özen S., Eldem B.

We aimed to evaluate the retina and the choroid in children with juvenile idiopathic arthritis (JIA) employing optical coherence tomography (OCT). This cross-sectional study, carried out between June 2017–December 2019, included JIA patients with (JIAU; n = 28) and without (JIAN; n = 65) uveitis and age-matched healthy controls (HC) (n = 102). Laboratory and demographic information of the children were obtained from hospital records. Activity of the disease was evaluated by the Juvenile Arthritis Disease Activity Score-71 (JADAS-71). Choroidal scans were obtained with spectral domain-OCT in enhanced-depth imaging (EDI)-OCT mode to assess choroidal thickness (ChT) at five locations (under the fovea, at 750 and 1500 μm nasal and temporal sections), luminal area (LA), stromal area (SA), total subfoveal choroidal area (TCA) and CVI (choroidal vascularity index). Central foveal thickness (CFT) and 1-mm diameter foveal thickness (FT) were calculated automatically through macular volume scan analysis. The choroid was significantly thicker in JIAU and JIAN patients than in HC at the subfoveal and at the 750N, 750T, 1500T points (p < 0.001, p = 0.009, p < 0.001, and p < 0.001, respectively). The CVI was lower in JIAU patients than in JIAN patients and HC (p = 0.02). Conversely, CFT was greater in JIAU patients as compared to the JIAN patients and HC (p = 0.02). Changes in chorioretinal OCT parameters in the absence of uveitis in JIA patients may reflect subclinical choroidal inflammation in these patients. Ophthalmologic examination, including choroidal imaging in a larger cohort, may clarify this aspect.

Özdamar Erol Y., Güngör A., Şekeryapan Gediz B.

To investigate the choroidal vascularity alterations of macula and peripapillary area in eyes with unilateral Fuchs uveitis (FU).This study included 18 eyes with unilateral FU and 18 healthy fellow eyes. The choroidal vascularity index (CVI) was analyzed, and the results were compared between eyes with FU and healthy fellow eyes (control group).The mean subfoveal (s)CVI (%) value was significantly lower in the FU group as compared with the control group: 60.92 ± 2.63 vs. 64.01 ± 2.54, respectively (p = .001). The mean pCVI (%) values of superior and inferior quadrant were significantly lower in the Fuchs group as compared with the control group:58.87 ± 4.48 vs. 61.98 ± 3.32, respectively, in superior quadrant (p = .035); and 57.29 ± 6.65 vs. 61.44 ± 4.76, respectively, in inferior quadrant (p = .014).The chronic continuous inflammation in FU causes inflammation-mediated thinning in the vascular area of the subfoveal and peripapillary choroid. The changes in the peripapillary region are remarkable in terms of the further glaucoma risk of these eyes.

Ozcelik-Kose A., Balci S., Turan-Vural E.

• Binarisation of the EDI-OCT images might be a useful technique to differentiate which layers of the choroid affected with the ocular diseases. • In patients with Fuchs uveitis syndrome vitreous condensation and chorioretinal scars are signs of involvement of the posterior segment. • We used new binarisation technique and demonstrated that structural changes in the luminal part of choroid in the affected eyes of these patients. This study aimed to investigate changes in the choroidal vascularity index (CVI) in eyes with Fuchs uveitis syndrome (FUS) and determine the effect of heterochromia on choroidal vascularity using binarisation of enhanced-depth imaging (EDI)-optical coherence tomography (OCT) images. The study included the affected eyes (FEs) and unaffected fellow eyes (NFEs) of 24 patients with unilateral FUS and the eyes of 30 healthy controls (HCs). The subfoveal total choroidal area (TCA) and the luminal area (LA) were determined by binarised EDI-OCT images using Image J software (National Institutes of Health, Bethesda, MD). The CVI value was calculated by dividing the LA value by the TCA value. The CVI values were significantly lower in FEs (58.8 ± 3.7 %) compared to NFEs (62.3 ± 3.9 %, p = 0.002) and HCs (61.1 ± 3.7 %, p = 0.008). The mean LA was significantly narrower in FEs than in NFEs (p = 0.047) and HCs (p = 0.001). Additionally, the mean CVI values were significantly lower in eyes with heterochromia compared to those without heterochromia (p = 0.024) in the affected eyes of patients with FUS. This study shows that there are significant quantitative structural changes, especially in the luminal part of the subfoveal choroid, in eyes with FUS. The choroid seems to be more affected in the presence of heterochromia. These findings might support posterior involvement and the chronicity of the disease.

Koçak N., Yeter V., Subaşı M., Yücel Ö.E., Can E.