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

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.

Inner Retinal Microvasculature Damage Correlates With Outer Retinal Disruption During Remission in Behçet's Posterior Uveitis by Optical Coherence Tomography Angiography

“…6,22 Two studies using OCTA described the perifoveal microvascular changes in BD that occur during the active phase. 6,23 However, no study has quantified the microvasculature of the different retinal layers in BD during remission and associated these changes with damage to the outer retina.…”

Optical Coherence Tomography With Angiography in Behçet Uveitis

“…The work of Somkijrungroj et al also found selective decreases in vascular density for the deep capillary plexus, even in eyes with normal avascular foveal zone as determined by angiography. 20 These findings suggest a degree of macular ischemia may be present in several stages of the disease. Being an important cause of decreased visual acuity, early detection by use of this new technology may be clinically relevant.…”

“…Avascular foveal area of the superficial capillary plexus was found to be significantly smaller than in the deep capillary plexus (0.47 vs. 1.94mm2; p<0.001), with a capillary perfusion ratio between the superficial and deep capillary plexus of 0.57±0.27, correlated with visual acuity, thereby suggesting that the deep capillary plexus may be more intensely affected than the superficial capillary plexus. 20 However, there was no comparison with a control group, limiting the findings of the study. 20 The results of our study, along with the two referred studies, suggest microcirculation alterations at the macular level for these patients, which can be shown by OCT-A.…”

“…20 However, there was no comparison with a control group, limiting the findings of the study. 20 The results of our study, along with the two referred studies, suggest microcirculation alterations at the macular level for these patients, which can be shown by OCT-A. The clinical significance of these alterations is not clear given the absence of prospective studies evaluating the stages where these alterations occur, and their relationship with the severity of the disease.…”

“…VISION PAN-AMERICA | JUL -SEP 2018 | VOL. 17 (3) jrungroj et al 2017 e Khairallah et al 2017) 19,20 that have analyzed Behçet uveitis patients with the OCT-A, finding alterations in macular perfusion in the superficial, and deep retinal plexus.…”