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COVID19
IN
CHILDREN
KSU
Hospital
1
b
C
c
Mohamed Ahmed ELShafie
MD, HMS alumni
Uveitis assessment
is complex
•Heterogeneity across the different uveitic phenotypes.
•Fluctuations with disease severity and flares.
The use of OCT in UVEITIS is increasing
Ideal biomarker for uveitis
•reliable.
•noninvasive.
•easy to acquire in routine clinical practice.
•large clinical databases available for validation
Clinical Grading
1ST
Anterior
chamber
cells
vitreous Haze
2nd
vitreous hyperreflective
dots (Haze)
ERM thickness increase
with uveitis duration
Vitreomacular
interface
3rd
In most eyes with uveitis and ERM, VA remains stable if ocular
inflammation and comorbidities are addressed appropriately.
Creamy white dots
Hyperreflective foci
4TH
inner retinal ischemia or
inflammatory
neurodegeneration
5TH
DRIL
most important reversible
cause of sight-loss
UME
6TH
why visual acuity
may not fully
recover to
baseline even
after UME
resolves.
irreversible disruption of retinal neural network and permanent visual acuity loss
Seven-year outcomes of uveitic macular edema: the Multicenter Uveitis Steroid Treatment
(MUST) Trial and Follow-up Study results. Ophthalmology. 2021 May ; 128(5): 719–728
each 100-μm reduction in CST = 6.5-letter increase in VA
20-percent reduction in CST should be used as a clinically
meaningful improvement in visual acuity
placoid syphilis
Integrity of
ellipsoid zone
7TH
measurement in the
acute stage of choroiditis
Choroidal
thickness
8TH
Monitor
TTT
Response
indicator of inflammatory
activity
choroidal
vascularity
index
9TH
Behcet disease
Sarcoidosis
Toxoplasmosis
Endogenous Candida
THANK YOU

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OCT biomarkers in uveitis.pptx

Editor's Notes

  1. greater in areas overlying the primary chorioretinal focus. toxoplasmic retinochoroiditis: round hyper-reflective nodule on the outer face of the focally detached posterior hyaloid(yellow arrow), as well as overlying the retina (green arrow). hyper-reflective full thickness retinal lesion (red asterisk
  2. ERM in IU VMT in sarcoidosis
  3. COMPLETE PVD
  4. HRF as deposits located within the walls of intraretinal microaneurysms and scattered throughout all retinal layers, forming confluent plaques in the outer plexiform layers. presence of HRF in the inner and outer retina is associated with worse VA. predict poor treatment response 
  5. derangement of the normal laminar inner retinal structure Foveal DRIL is associated with worse VA at baseline and follow-up visits.Resolution of UME and subretinal fluid occurs after starting treatment. patches of derangement
  6. neurosensory retina has a degree of elasticity Within limits, the continuity of bipolar cells is maintained even with fluid buildup and the connections between the photoreceptor and ganglion cell layers remain viable. if the edema exceeds elastic limits, bipolar axons snap, compromising transmission pathway.
  7. Even in the absence of cystoid spaces and SRF, retinal thickness “Non-cystic thickening,” using the central subfield thickness and perivascular thickening are valuable markers of disease activity on OCT active birdshot chorioretinopathy  FFA:perivascular leakage immunomodulatory treatment
  8. EZ integrity reflects the anatomic arrangement of photoreceptor outer segments EZ loss with rapid reconstitution after starting penicillin. intact EZ (arrows) loses its integrity (bracket) within area of UME. mild SRD causing significant EZ disruption degree of EZ disruption has been associated with intensity of corticosteroid therapy required to treat UME
  9. (i.e., in Vogt-Koyanagi-Harada disease) and for monitoring inflammatory activity. 
  10. ratio of vascular area to the total choroidal area Luminal Area (LA): Area of dark pixels in the choroid Stromal Area (SA): Area of light pixels in the choroid
  11. 1 retinitis spare RPE and choroid 2 on top of retina 3 intraretinal and fluid and choroid chorioretinitis 4 protrude from choroid to retina through RPE