Spectral domain optical coherence tomography findings of patients with ankylosing spondylitis

Kim M., Kim R.Y., Park Y.

Purpose: To assess choroidal thicknesses and choroidal vascularity index (CVI) in HLA-B27-associated uveitis.Methods: Medical records of 45 treatment-naive unilateral HLA-B27-associated uveitis patients presenting with first episode and with onset time of < 1-week were reviewed.Results: Mean choroidal thickness was 275.98 ± 71.62 in acute phase and 254.93 ± 73.48 after resolution (p = .003). Mean CVI was 34.75 ± 3.08 in acute phase and 33.56 ± 2.48 after resolution (p < .001). Interestingly, even in fellow eyes, there were relative retinal and choroidal thickening and relative choroidal vascular engorgement in acute phase, but these differences were not significant. Degree of anterior chamber inflammation was correlated with relative choroidal vascular engorgement (p = .001) and choroidal thickening (p = .044).Conclusion: Eyes with acute HLA-B27-associated uveitis exhibited choroidal thickening with increased choroidal vascularity that subsequently decreased after uveitis resolution. These were evident even in patients without posterior segment involvement.

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

Purpose. To describe and correlate the degree of anterior segment inflammation with central retinal and choroidal thickness throughout the treatment period (in the course of follow-up) in the eyes affected with acute anterior uveitis in the patients with seronegative spondyloarthropathy (subgroup: ankylosing spondylitis). Methods. Thirty eyes of 30 consecutive Caucasian patients with HLA-B27-associated acute anterior uveitis were included in this study. The flare, AC cell number, and central retinal/choroidal thickness were determined at each visit by optical coherence tomography and laser flare photometry. Treatment consisted of topical corticosteroids. Statistical analysis was performed by MathWorks Matlab software. Results. In the follow-up period, central retinal thickness was increased in the first 9-10 days and then decreased until stabilization (after 5-6 weeks). The flare and AC cell number decreased rapidly at the beginning of the treatment, in the first 10 days, and thereafter, slower decrease could be observed until complete resolution of inflammation. Statistically significant, positive correlation was found between initial laser flare value and maximal central retinal thickness (r=0.881, p<0.001). Positive correlation between flare and retinal thickening was observable throughout the treatment period. Central choroidal thickness was decreased also significantly during the follow-up (p<0.001). Conclusions. The retina and choroid may play a biomarker function in the anterior segment inflammation of the eye in the patients with seronegative spondyloarthropathy.

Kal A., Duman E., Sezenöz A.S., Ulusoy M.O., Kal Ö.

To evaluate whether retrobulbar blood flow and choroidal thickness (CT) are affected in patients with rheumatoid arthritis (RA), and the relationship between these values. We evaluated 40 eyes of 20 RA patients and 40 eyes of 20 healthy controls. The enhanced depth imaging optical coherence tomography, color Doppler imaging, was held. Statistical analysis was performed. Peak systolic velocity (PSV) of ophthalmic (OA) and central retinal artery (CRA) were significantly higher in RA. No significant difference was observed when end-diastolic velocity (EDV) of OA and CRA was compared between the groups. The resistivity index (RI) of OA and CRA was higher in RA. Perifoveal/subfoveal CT was lower in RA. Negative correlation was detected between the RI of OA and the perifoveal CT, and a positive correlation was detected between RI of CRA and CT. Ocular hemodynamics is effected by RA and can exaggerate ocular complications of various vascular diseases such as diabetes mellitus, hypertension, retinal vascular occlusions.

Karaca C., Karaca Z., Kahraman N., Sirakaya E., Oner A., Mirza G.E.

To evaluate choroidal thickness (CT) in patients with Cushing syndrome (CS) with enhanced depth imaging optical coherence tomography.Twenty-eight patients with CS and 38 healthy volunteers were enrolled in this observational cross-sectional study. Patients with newly diagnosed CS who have been admitted to Erciyes University Department of Endocrinology in 3 years time interval were compared with age- and sex-matched healthy volunteers. Choroidal thickness was measured at the fovea and 2 points nasal and 2 points temporal to the fovea with 500-μm intervals each.Choroidal thickness measurements were higher in patients with CS than in the control group at all examination points; however, the difference was found to be significant at the center of the fovea (367.8 ± 94.4 μm vs. 329 ± 90.5 μm) and 1,000 μm temporal to the fovea. Choroidal thickness measurements were significantly higher in adrenocorticotrophic hormone (ACTH)-dependent CS group than in the control group at all measurement points (CT at fovea 388.2 ± 92.4 μm vs. 329.1 ± 90.5 μm). All CT measurements were found to be correlated with ACTH levels.Cushing syndrome is associated with increased CT. The ACTH-dependent CS may increase CT more than ACTH-independent CS. This effect may be directly related to ACTH itself or increased plasma cortisol levels or both.

Türkcü F.M., Şahin A., Yüksel H., Akkurt M., Uçmak D., Çınar Y., Yıldırım A., Çaça İ.

The purpose of this study was to evaluate choroidal thickness (CT) in patients with psoriasis using enhanced depth imaging optical coherence tomography (EDI-OCT) and to determine its relationship with psoriasis activity indices. In this prospective study, EDI-OCT images were obtained in consecutive patients with psoriasis and in age–gender-matched healthy individuals. Comprehensive ophthalmic examination and EDI-OCT evaluation were performed. CT was measured in the subfoveal area. Correlation analyses were performed to identify the relationship of the CT with disease duration and clinical disease activity score. In total, 65 individuals were evaluated in this study, 35 with psoriasis and 30 controls. The mean disease duration of the patients with psoriasis was 15.7 ± 8.8 years (0.3–34 years). There was no difference between groups with respect to age and gender (p = 0.695 and p = 0.628, respectively). Five of the 35 patients with psoriasis had anterior uveitis. None of the patients with psoriasis had signs of posterior uveitis. CT was significantly higher in the psoriasis group than that of control subjects (p < 0.001). The mean central foveal thickness was comparable between groups (p = 0.672). There was also no significant correlation between EDI-OCT, disease activity score, and disease duration (p < 0.05). Choroidal thickness is increased in psoriasis patients. Large serial and comparative studies are necessary to evaluate EDI-OCT, an examination that may be helpful in understanding the effects of psoriasis on the eye and its pathophysiology.

Zhang X., Iverson S.M., Tan O., Huang D.

We determined the effect of Fourier-domain optical coherence tomography (OCT) signal strength index (SSI) and cropping on retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) scan repeatability and measurement thickness.Eyes were enrolled in the longitudinal Advanced Imaging for Glaucoma Study. At each visit, three repeat scans from the optic nerve head and macular protocols were obtained. Each measurement was associated with an SSI value from 0 to 100. Measurements with similar SSI scores were grouped to calculate repeatability defined as pooled standard deviation. Within-visit analysis was used to determine how measured thickness changed in relation to change in SSI level.The study included 1130 eyes of 569 patients. Cropped images yielded significantly worse repeatability and they were excluded from subsequent analyses. The within-visit repeatability for RNFL and GCC measurements were significantly better with higher signal strength, and optimal cutoffs were SSI ≥ 37 and ≥ 44, respectively. The coefficient of variation was

Onal I.K., Yuksel E., Bayrakceken K., Demir M.M., Karaca E.E., Ibis M., Alizadeh N., Sargin Z.G., Hondur A.M., Arhan M.

Moore D.B., Jaffe G.J., Asrani S.

To evaluate optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) measurements in patients with active and quiescent uveitis with and without glaucoma and compare results to the published age-adjusted normative data.Comparative, retrospective pilot study.Consecutive patients with uveitis who underwent OCT RNFL measurements between December 2011 and October 2012 were identified: 76 uveitic eyes without glaucoma and 135 uveitic eyes with glaucoma.We conducted OCT of the RNFL.Global and sectoral RNFL thickness measurements.In 19 nonglaucomatous, uveitic eyes with active inflammation, mean global and all sectoral RNFL measurements were greater than the normative 95th percentile. The mean global RNFL OCT measurement was 140.5 microns in such eyes compared with 107.8 microns in the 57 nonglaucomatous, quiescent, uveitic eyes (P=0.008). These measurements were significantly higher than the average of 95.3 microns reported in normal eyes (P

Ilhan N., Ustun N., Tuzcu E.A., Coskun M., Yagiz A.E., Ilhan O., Parlakfikirer N.

Zagora S.L., McCluskey P.

This article reviews recent advances in the understanding of the ocular manifestations of seronegative spondyloarthropathies.Ocular inflammatory disorders are common and important disease manifestations in patients with seronegative spondyloarthropathy, with anterior uveitis being the most common. There is a strong association between affected patients and the human leukocyte antigen B27. Local corticosteroid treatment is usually effective, but chronic or refractory uveitis responds well to immunosuppressive drugs that are effective for arthritis. Recent studies have highlighted the possible benefits of a number of biologic agents, including tumor necrosis factor-alpha inhibitors in such patients.Uveitis is the most common ocular manifestation in patients affected by seronegative spondyloarthropathies. Both genetic and environmental factors play a role in its pathogenesis. As it tends to affect the young adult population, it carries a significant personal and population burden. Immunomodulatory therapy that also acts as a corticosteroid sparing therapy can be effective in controlling chronic uveitis in patients with spondyloarthropathy.

Ayhan Tuzcu E., Ustun N., Ilhan N., Yagiz E., Daglioglu M.C., Coskun M., Ilhan O., Keskin U., Yengil E.

To assess the thickness of the retinal nerve fibril layer (RNFL) in cases with ankylosing spondylitis (AS).The study included 40 AS patients who had no history of acute and/or previous uveitis and 50 healthy controls. After detailed ocular examination, the thickness of the peripapillary RNFL, the macula, and the ganglion cell-inner plexiform layers (GCIPL) were measured by spectral domain optic coherence tomography (SD-OCT). The correlation between the duration of the disease and the thickness of the RNFL, the macula, and the GCIPL were analyzed in the patients who had AS. These patients were then placed into 2 groups according to their BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) score: patients with BASDAI score

Kola M., Kalkisim A., Karkucak M., Turk A., Capkin E., Can I., Serdar O.F., Mollamehmetoglu S., Ayar A.

Purpose: To investigate posterior segment (PS) findings in the eye in patients with ankylosing spondylitis (AS).Eighty-four patients with AS and 63 healthy controls were enrolled. PS evaluations were performed using optical coherence tomography (OCT). Foveal thickness, peripapillary retinal nerve fiber layer thickness, macular volume, ganglion cell complex, and choroidal thickness (CT) values were compared between the groups.Mean CT was higher in patients with AS (326.5 ± 71.5 µm) than in the healthy controls (286.2 ± 59.5 µm) (p = 0.001). There was no significant difference between patients with AS and the healthy control group in terms of other OCT parameters. There was also no significant correlation between CT, AS activity index, and disease duration.This is the first study to evaluate effects of AS on CT. CT was high in patients with AS compared to healthy controls.

Kim M., Kim H., Kwon H.J., Kim S.S., Koh H.J., Lee S.C.

To evaluate the change in subfoveal choroidal thickness between active and quiescent phases of Behcet's posterior uveitis and compare this with the healthy population using enhanced depth imaging optical coherence tomography (EDI-OCT).Thirty eyes from 30 patients with Behcet's posterior uveitis (mean age, 47.03 ± 11.01 years) were retrospectively enrolled in the study. Their subfoveal choroidal thickness was measured using EDI-OCT in the active and quiescent phases of Behcet's uveitis, and compared with the age, sex, and spherical equivalent-matched healthy population. Changes in retinal vascular leakage on fluorescein angiography (FA) were correlated with the changes in subfoveal choroidal thickness.Mean subfoveal choroidal thickness in the acute phase of Behcet's uveitis was significantly greater than that in the quiescent phase (398.77 ± 155.59 μm versus 356.72 ± 141.09 μm; P = 0.004). Subfoveal choroidal thickness in the quiescent phase was also significantly greater than that of the healthy population (259.96 ± 65.16 μm; P < 0.0001). There was a statistically significant association between the change in subfoveal choroidal thickness and the change in vascular leakage revealed by FA (ρ = 0.381, P = 0.046). Subfoveal choroidal thickness in the uninvolved fellow eyes of patients with unilateral Behcet's uveitis was also evaluated and it was significantly greater than that of the healthy population (n = 13 eyes; P = 0.001) CONCLUSIONS: This study found choroidal thickening during the active phase of Behcet's posterior uveitis. Subfoveal choroidal thickness during the quiescent phase was also significantly greater than in normal eyes. The degree of reduction in choroidal thickening was significantly correlated with improvement in retinal vascular leakage as revealed by FA.

Coskun E., Gurler B., Pehlivan Y., Kisacik B., Okumus S., Yayuspayı R., Ozcan E., Onat A.M.

Investigation of subfoveal choroidal thickness in Behçet disease (BD) with enhanced depth imaging optical coherence tomography (EDI-OCT).The study included 35 patients with posterior uveitis (PU) associated with BD, 35 patients with BD without ocular involvement, and 30 healthy controls.There were no significant differences between the groups in terms of age, gender, axial length, or spherical equivalent refractive error. The mean subfoveal choroidal thickness was thinner in eyes with PU than in eyes without PU and healthy controls (p = 0.026).EDI-OCT is a beneficial test for evaluating choroid morphology in BD. Thinning of the subfoveal choroidal tissue has been observed in patients with BD-associated PU.

Dalgliesh J.D., Tariq Y.M., Burlutsky G., Mitchell P.

To determine interocular differences in retinal parameters in a population of young adults using spectral-domain optical coherence tomography.In the Sydney Adolescent Vascular Eye Study, young adults aged 16 to 19 years received a standardized eye examination encompassing retinal photography, spectral-domain optical coherence tomography (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA) and best-corrected visual acuity. Interocular differences in retinal nerve fiber layer (RNFL) and macular parameters together with sex and ethnic variations for these differences were determined.In the 1500 subjects tested, right eyes had thicker average RNFL than left eyes (0.3 μm, P=0.0074). There were no significant interocular differences in central macular or macular cube average thickness. After adjusting for interocular difference in axial length, right eyes had slightly smaller total macular volume than left eyes (-0.0082 mm, P=0.008). The 2.5% to 97.5% limits of asymmetry were 9.3 μm for average RNFL, 8 μm for average macular thickness, and 0.20 mm for total macular volume. In the outer inferior quadrant, there was a greater macular thickness asymmetry in females than males (-0.7 μm, P=0.037). In the inferior RNFL quadrant (-2.6 μm, P=0.0013) and in the outer inferior macular quadrant (1.6 μm, P=0.0018), white individuals had greater symmetry than East Asians.In this study, we report the degree of interocular symmetry of RNFL and macular parameters measured by Cirrus HD-OCT in healthy young adults.

Toptan M., Aksoy M.

The purpose of the study was to compare retinal pigment epithelium (RPE) thickness in patients with psoriasis and vitiligo.The right eyes of 67 psoriasis and 65 vitiligo patients and 71 healthy individuals were included in the study. The RPE thicknesses were analyzed with the spectral domain-optical coherence tomography after routine ophthalmological examinations (SD-OCT).No statistically significant differences were detected when psoriasis and vitiligo patients were compared in terms of RPE levels (p = 0.033). When compared with the Control Group, no significant differences were found with psoriasis patients, but a significant difference was detected with vitiligo patients (p = 0.515, p = 0.001, respectively).Although no changes were detected in RPE in psoriasis, the decreased RPE thickness in vitiligo may be an indicator of the effect of melanin loss on the posterior segment of the eye in vitiligo. For this reason, measurement of RPE thickness with OCT can help in detecting the damage in vitiligo patients.