Author: Kajree Gupta (India)
Co-authors: Vishali Gupta, Aniruddha Agarwal, Ajay Jurangal
Purpose
To compare the clinical usefulness of MultiColor confocal scanning laser ophthalmoscope imaging (MCI) with conventional color fundus photography (CFP) in posterior uveitis
Setting/Venue
Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Methods
Prospective cross-sectional study of consecutive patients with posterior uveitis who underwent concurrent imaging on MCI and CFP at a single tertiary referral centre. Clinical evaluation and multimodal chorioretinal imaging were used as gold standard. Two independent masked graders analyzed the images for the presence of vitreo-retinal surface abnormalities, depth of lesions, presence of retinal fluid and hemorrhage, features of healed lesion, and disease activity on MCI with Multicolor CSLO Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany) and CFP on VISUPAC Digital Imaging System ( Carl Zeiss Meditec, Jena, Germany). Inter-grader agreement was calculated using the Kappa (K) coefficient. Sensitivity and specificity were analyzed for each finding on CFP, MCI, infrared reflectance, green reflectance and blue reflectance images in reference to the gold standard.
Results
This study included 69 eyes of 43 patients. For the parameters analyzed, K value ranged from 0.61 – 1.00 indicating good to very good inter-grader agreement. Sensitivity for detection of epiretinal membrane was 20% on MCI and 10% on CFP. Retinochoroiditis was detected in 16.7% of cases on MCI and in 100% on CFP. Choroiditis was seen in 84.5% on MCI and in 100% on CFP. Vasculitis was detected in 50% of cases on MCI and in 100% on CFP. Optic neuritis was detected in 70% of cases on CFP and in 100% on CFP. Intraretinal fluid was not detected on MCI but in 15% cases on CFP. Intraretinal hemorrhage was detected in 40% cases on MCI and in 100% on CFP. Subretinal fibrosis was identified in 76.2% of cases on MCI and in 100% on CFP. Scarring and atrophy was identified in 96.3% cases on MCI and in 100% on CFP. Inner retinal striae were detected in 66.7% of cases on MCI and in 50% on CFP. Choroidal neovascularization was seen in 0% eyes on MCI and in 11.1% on CFP. Active disease was identified in 56.6% cases on MCI and in 100% on CFP.
Conlusions
Epiretinal membrane and inner retinal striae were better identified on MCI in comparison to CFP. For detection of depth of lesion, intraretinal hemorrhage and fluid, subretinal fibrosis, choroidal neovascularization and disease activity both for retinochoroiditis and choroiditis, MCI was inferior to CFP. Lesions of active posterior uveitis were poorly identified on MCI. MCI cannot be applied as standalone modality for posterior uveitis as it may lead to misinterpretation of pathology.
Financial Disclosure
None
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