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    Multimodal imaging approach useful in treatment of uveitis

    Selective imaging technologies can offer identifying data, motivation for patients

    Successful imaging for the group of diseases known as uveitis depends on the specific underlying etiology. Tailoring the imaging approach using a variety of imaging methods, which are often complementary, can yield the maximum amount of information. This approach is useful not only for diagnosis and management of patients, but increasingly in clinical trials.

     

    Fluorescein angiography

    Fluorescein angiography (FA) is a frequently used modality in the diagnosis of uveitis.

    To diagnose cystoid macular edema, the finding of an early course perifoveal hyperfluorescence, along with a late petalloid leakage and optic nerve hyperfluorescence, can identify an inflammatory etiology for the macular edema (ME) as opposed to a non-leaking form.

    In the white dot syndromes, it can be useful to differentiate multiple evanescent white dot syndrome (MEWDS), birdshot, and multifocal choroiditis and panuveitis (see Figures 1, 2, and 3).

    Patients with Vogt-Koyanagi-Harada disease (VKH), scleritis, and sympathetic ophthalmia have a characteristic appearance of punctate hyperfluorescence, which then pools in the subretinal space in the late angiographic phase, and which corresponds to subretinal fluid.

    In placoid syphilitic uveitis, there is a characteristic appearance of a yellowish grey macular lesion on color fundus photography and on fluorescein angiography, a hypofluorescent appearance early that fills in partially in the later frames.

    Acute multifocal placoid pigment epitheliopathy (AMPPE) and serpiginous choroiditis, in the acute disease phase, have the classic “blocks early, stains late” appearance, meaning the lesions are hypofluorescent early in the angiogram, and those lesions then stain in the late phase angiogram. In the late stages of AMPPE and serpiginous uveitis, there is staining of the lesions and a hyperfluorescent rim can be seen around the lesion, which is from the intact choriocapillaris.

    In retinitis, it may be hard to distinguish an insult to the retina, which turns white, from a vascular occlusion. The finding of the “block-early, stain-late” appearance is helpful to identify retinitis. In contrast, in an eye with ischemic damage, there may be mild hypofluorescence, or no abnormality, without late hyperfluorescence.

    ICG angiography

     

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