Choroidal change in acute anterior uveitis associated with human leukocyte antigen-B27

Abstract

PurposeTo evaluate choroidal changes in eyes with acute anterior uveitis associated with human leukocyte antigen (HLA)-B27MethodsIn 44 patients with first-onset, unilateral, acute-onset (<1 week) anterior uveitis for which diagnostic work-ups revealed positivity only for HLA-B27, wide-field three-dimensional volumetric raster scan using swept-source optical coherence tomography was performed for both eyes. Choroidal thickness was measured by automated segmentation and thickness mapping and compared between eyes with uveitis and the fellow eyes at baseline. Choroidal thickness was compared before and after topical and/or systemic corticosteroid therapy. Relative choroidal thickening was defined as the choroidal thickness of the uveitic eye minus that of the corresponding eye and correlated with the degree of intraocular inflammation.ResultsCompared to the fellow eyes, eyes with acute anterior uveitis showed significant choroidal thickening on the subfoveal and parafoveal areas at baseline (all P <0.05). En face choroidal imaging showed dilation of large choroidal vessels on the macula. Relative choroidal thickening significantly correlated with the degree of anterior chamber inflammation at baseline (correlation coefficient = 0.341, P = 0.023). After treating inflammation, the choroid on the macula thinned significantly (from 262.1 ± 66.5 to 239.5 ± 61.0 μm in the subfoveal choroid, P<0.001).ConclusionsEyes with HLA-B27-associated anterior uveitis showed significant choroidal thickening at acute phase that subsequently decreased after treatment, indicating subclinical choroidal inflammation in the eyes. Choroidal thickness might indicate disease activity in acute anterior uveitis associated with HLA-B27.

Evaluation of choroidal parameters in eyes at the first onset of acute anterior uveitis

“…It has previously been demonstrated that CT is affected over the course of AAU. In HLA-B27 positive patients, the values of subfoveal CT were higher in eyes with AAU at the first onset compared with FEs [4]. A B-scan of the macular region in those eyes also revealed dilated large choroidal vessels.…”

“…Development of optical coherence tomography (OCT) technology also showed subclinical involvement of the posterior retina and choroid in some cases of AAU [2, 3]. Involvement of the choroid may cause changes in choroidal thickness (CT) or correlate with lower visual acuity in those patients [3, 4]. The OCT technology provided an opportunity to improve the monitoring of uveitic patients.…”

“…Additionally, there is no agreement among researchers on the influence of AAU on CT. Available reports are based mainly on a single measurement of CT in the subfoveal region that is performed manually by the authors or, rarely, on thickness-mapping of the choroid [4]. This methodology does not cover all choroid parameters and can lead to biased results.…”

The state of the choroid in children with anterior uveitis assessed by optical coherence tomography

“…Толщина сосудистой оболочки в период активного воспаления также превышала норму [19]. Полученные результаты согласуются с данными большинства исследований взрослых с острыми передними увеитами, у которых обнаружено увеличение толщины сосудистой оболочки в период активного воспаления [8][9][10][12][13][14], что может быть обусловлено расширением сосудов, воспалительной инфильтрацией и отеком на фоне повышения их проницаемости. Нами отмечена худшая визуализация сосудов хориоидеи в периоды обострения увеита, что, очевидно, вызвано накоплением в межсосудистых пространствах экссудата, акустическая плотность которого сопоставима с плотностью воспаленной сосудистой стенки.…”

“…Попытки оценить роль этого параметра при передних увеитах [7][8][9][10][11][12][13][14] дали противоречивые результаты. В ряде работ обнаружено увеличение толщины сосудистой оболочки в субфовеолярной и парафовеолярной зонах в период активности воспаления [8,10,[12][13][14], а H. Yan и соавт. [9] продемонстрировали ее уменьшение при неактивном переднем увеите.…”