OCT Patterns of Macular Edema in Intermediate Uveitis

Objective. To evaluate characteristic OCT morphological characteristic of initial presentation and chronic recurrent macular edema (ME) in patients with intermediate uveitis.

Materials and methods. The study included 35 patients (46 eyes) with uveitic macular edema in intermediate uveitis. The first episode of macular edema was diagnosed in 20 patients (26 eyes), 15 patients (20 eyes) present with chronic recurrent macular edema. OCT was performed on the Optovue RTVue XR Avanti. The following OCT morphological characteristic were evaluated: integrity of IS/OS line, the presence of hyperreflective foci, inner nuclear layer cysts, Henle fibers layer cysts, small single cysts, diffuse retinal thickening without cystic changes, the presence of subretinal detachment.

Results. Four OCT morphological variants of uveitic macular edema were identified: diffuse macular edema, small single cysts, cysts in Henle fibers layer and the inner nuclear layer with and without subretinal detachment. In the group with diffuse macular edema, the median duration of macular edema was 3 months, macular edema with Henle fibers cysts, inner nuclear layer cysts with subretinal detachment presented after 5 months (median), small single cysts and cystic changes in the layer of Henle fibers and the inner nuclear layer were detected at later times (12 and 36 months, respectively). A strong negative correlation was found between best-corrected visual acuity and central retinal thickness in chronic recurrent uveitic macular edema (correlation coefficient — 0.7, p = 0.0001), while a moderate negative correlation was established in macular edema at initial presentation (correlation coefficient — 0.55, p = 0.0031). Integrity of IS/OS line was observed significantly more often (p = 0.002) in chronic recurrent macular edema (10 (83.3%)) than at initial presentation (2 (16.6%)). In the presence of IS/OS disruption, best-corrected visual acuity was significantly lower (p = 0.016).

Conclusion. Identified four OCT morphological variants of uveitic macular edema were characterized by different periods of its duration, which may reflect different stages of macular edema evolution. Chronic recurrent macular edema and ME at initial presentation in uveitis are distinguished by different OCT predictors, which should be taken into account in assessing the effectiveness of treatment and prognosis of visual acuity.

1. Fardeau C, Champion E, Massamba N, LeHoang P. Uveitic macular edema. Eye (Lond). 2016 Oct;30(10):1277–1292. doi: 10.1038/eye.2016.115.

2. Panova IE, Drozdova EA. Uveity. Moscow: Medical Information Agency, 2014 (In Russ.).

3. Arbeneva NS, Chekhova TA, Bratko VI, Obukhovа OO, Gorbenko OM, Shvayuk AP, Poveshchenko OV, Trunov AN, Chernykh VV. Effect of complex treatment using platelet autoplasma on clinical and laboratory parameters of patient with endogenous uveitis and macular edema. Siberian scientific medical journal 2019;39(5):110–118 (In Russ.). doi: 10.15372/SSMJ20190513.

4. Lardenoye CW, van Kooij B, Rothova A. Impact of macular edema on visual acuity in uveitis. Ophthalmology. 2006 Aug;113(8):1446–1449. doi: 10.1016/j.ophtha.2006.03.027.

5. Rothova A, Suttorpvan Schulten MS, Frits Treffers W, Kijlstra A. Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol. 1996 Apr;80(4):332–336. doi: 10.1136/bjo.80.4.332.

6. AccorintiM, OkadaAA, Smith JR, GilardiM. Epidemiology ofMacular Edema inUveitis. OculImmunolInflamm. 2019;27(2):169–180. doi: 10.1080/09273948.2019.1576910.

7. Daruich A, Matet A, Moulin A, Kowalczuk L, Nicolas M, Sellam A, Rothschild PR, Omri S, Gélizé E, Jonet L, Delaunay K, De Kozak Y, Berdugo M, Zhao M, Crisanti P, BeharCohen F. Mechanisms of macular edema: Beyond the surface. Prog Retin Eye Res. 2018 Mar;63:20–68. doi: 10.1016/j.preteyeres.2017.10.006.

8. Klaassen I, Van Noorden CJ, Schlingemann RO. Molecular basis of the inner blood retinal barrier and its breakdown in diabetic macular edema and other pathological conditions. Prog Retin Eye Res. 2013 May;34:19–48. doi: 10.1016/j.preteyeres.2013.02.001.

9. Das A, McGuire PG, Rangasamy S. Diabetic Macular Edema: Pathophysiology and Novel Therapeutic Targets. Ophthalmology. 2015 Jul;122(7):1375–1394. doi: 10.1016/j.ophtha.2015.03.024.

10. Munk MR, Bolz M, Huf W, Sulzbacher F, Roberts P, Simader C, Rückert R, Kiss CG. Morphologic and functional evaluations during development, resolution, and relapse of uveitisassociated cystoid macular edema. Retina. 2013 Sep;33(8):1673– 1683. doi: 10.1097/IAE.0b013e318285cc52.

11. Ossewaardevan Norel A, Rothova A. Imaging methods for inflammatory macular edema. Int Ophthalmol Clin. 2012;52(4):55–66. doi:10.1097/IIO.0b013e318266bf14.

12. Iannetti L, Accorinti M, Liverani M, Caggiano C, Abdulaziz R, PivettiPezzi P. Optical coherence tomography for classification and clinical evaluation of macular edema in patients with uveitis. Ocul Immunol Inflamm. 2008;16(4):155–160. doi: 10.1080/09273940802187466.

13. Grewal DS, O’Sullivan ML, Kron M, Jaffe GJ. Association of disorganization of retinal inner layers with visual acuity in eyes with uveitic cystoid macular edema. Am J Ophthalmol. 2017;177:116–125. doi: 10.1016/j.ajo.2017.02.017.

14. Ossewaardevan Norel J, Berg EM, Sijssens KM, Rothova A. Subfoveal serous retinal detachment in patients with uveitic macular edema. Arch Ophthalmol. 2011 Feb;129(2):158–162. doi: 10.1001/archophthalmol.2010.337.

15. Lehpamer B, Moshier E, Goldberg N, Ackert J, Godbold J, Jabs DA. Subretinal fluid in uveitic macular edema: effect on vision and response to therapy. Am J Ophthalmol. 2013 Jan;155(1):143–149. doi: 10.1016/j.ajo.2012.06.028.

16. Tran TH, de Smet MD, Bodaghi B, Fardeau C, Cassoux N, Lehoang P. Uveitic macular oedema: correlation between optical coherence tomography patterns with visual acuity and fluorescein angiography. Br J Ophthalmol. 2008 Jul;92(7):922–927. doi: 10.1136/bjo.2007.136846.

17. Iannetti L, Scarinci F, Alisi L, Armentano M, Sampalmieri L, La Cava M, Gharbiya M. Correlation between Morphological Characteristics of Macular Edema and Visual Acuity in Young Patients with Idiopathic Intermediate Uveitis. Medicina (Kaunas). 2023 Mar 8;59(3):529. doi: 10.3390/medicina59030529.

18. Markomichelakis NN, Halkiadakis I, Pantelia E, Georgalas I, Chrysanthi K, Theodossiadis P, Moschos M, Theodossiadis G, Kouvatseas G. Course of macular edema in uveitis under medical treatment. Ocul Immunol Inflamm. 2007 Mar Apr;15(2):71–79. doi: 10.1080/09273940701244509.

19. TomkinsNetzer O, Lightman S, Drye L, et al.; Multicenter Uveitis Steroid Treatment Trial Research Group. Outcome of treatment of uveitic macular edema: the multicenter uveitis steroid treatment trial 2year results. Ophthalmol. 2015;122(11):2351–2359. doi: 10.1016/j.ophtha.2015.07.036.

20. AlvarezGuzman C, BustamanteArias A, ColoradoZavala MF, RodriguezGarcia A. The impact of central foveal thickness and integrity of the outer retinal layers in the visual outcome of uveitic macular edema. Int J Retina Vitreous. 2021 Apr 27;7(1):36. doi: 10.1186/s40942-021-00306-8.