Multimodal imaging enhanced by indocyanine green angiography in syphilitic uveitis
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Yes
Purpose
To characterize fundus abnormalities associated with syphilitic uveitis (SU) on multimodal imaging (MI) enhanced by indocyanine green angiography (ICGA).
Methods
Prospective investigation of patients admitted for treatment of SU at a referral hospital between 2018 and 2019, including 24 patients. Eight patients from a pilot analysis, previously admitted, were also included, comprising 32 patients. MI consisting of ICGA, fluorescein angiography(FA), autofluorescence(FAF), and optical coherence tomography(SD-OCT), upon hospital admission and discharge. Demographic and clinical examination data were analyzed.
Results
62 eyes of 32 patients with sufficiently transparent media were analyzed, with mean age of 43 years, 78% man and 25% with HIV coinfection. VDRL ranged from 1:32-1:4096. MI detected unrecognized posterior segment involvement in 11 eyes, improving the accuracy of uveitis classification by 19% (11/57). ICGA disclosed evidence of choroidal inflammation manifested by geographical hypocyanescence in 27/58 eyes (47%) of 20/32 (63%) patients, dark dots in 33/46 eyes of 22/28 patients (79%) and speckled hipocyanescence in 52/56 eyes (93%) of all 32 patients. On FA, placoid hyperfluorescence was identified in 16/54 eyes (30%) of 13/31 patients (42%). SD-OCT abnormalities were found in 53/59 eyes (89.8%) and ELM disruptions on SD-OCT were associated with of worse BCVA at presentation and upon discharge (P<0.05)
Conclusion
MI was superior to clinical ophthalmic examination for detection of inflammation associated with syphilitic uveitis. Choroidal hypocyanescent changes were the most common abnormality revealed by MI. ELM disruption on SD-OCT was predictive of more severe intraocular inflammation before and after therapy
Conflict of interest
No
1
Last name
CENACHI
Initials of first name(s)
S
Department
Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
City
Belo Horizonte
Country
Brazil
2
Last name
NETO
Initials of first name(s)
V
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
City
Belo Horizonte
Country
Brazil
3
Last name
AZEVEDO
Initials of first name(s)
D
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
City
Belo Horizonte
Country
Brazil
4
Last name
CAMPOS
Initials of first name(s)
W
Department
Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
City
Belo Horizonte
Country
Brazil
5
Last name
Vasconcelos-Santos
Initials of first name(s)
DV
Department
Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
City
Belo Horizonte
Country
Brazil
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