Characterization of Retinal Microvascular Abnormalities in Birdshot Chorioretinopathy Using OCT Angiography

TL;DR

This study uses OCT angiography to show that birdshot chorioretinopathy causes reduced retinal blood vessel density, which could help track disease severity.

Contribution

The study introduces OCT angiography as a potential biomarker for monitoring retinal microvascular changes in birdshot chorioretinopathy.

Findings

Birdshot chorioretinopathy eyes showed significantly lower vessel density compared to controls in both superficial and deep capillary plexus.

Enlarged foveal avascular zone area was observed in BCR eyes, particularly in the deep capillary plexus.

Longer disease duration and treatment-naive status were associated with decreased vessel density in BCR patients.

Abstract

To characterize changes in the retinal microvasculature in eyes with birdshot chorioretinopathy (BCR) using OCT angiography (OCTA).

Retrospective, observational, single center.

Twenty-eight patients (53 eyes) with BCR and 59 age-matched controls (110 eyes).

En face OCTA images of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of each eye were assessed for the presence of microvascular abnormalities and used to measure the vessel and foveal avascular zone (FAZ) areas. A longitudinal analysis was performed with a representative cohort of 23 BCR eyes (16 patients) at baseline and at a 2-year time point.

Whole-image vessel density (VD, %), extrafoveal avascular zone (extra-FAZ) VD (%), and FAZ area (%) were calculated and compared between control and BCR eyes. The frequency of microvascular abnormalities in BCR eyes was recorded.

In the SCP, increased intercapillary space and capillary loops were common features present on OCTA images. Whole-image and extra-FAZ VD were lower in the BCR group compared with controls (P < 0.0001 [SCP and DCP]). Foveal avascular zone area was enlarged in BCR eyes (P = 0.0008 [DCP]). Worsening best-corrected visual acuity was associated with a decrease in whole-image and extra-FAZ VD in the SCP (P < 0.0001 for both) and the DCP (P < 0.005 for both). Multivariable analysis, with vessel analysis parameters as outcomes, demonstrated that increasing age, increasing disease duration, lower central subfield thickness, and treatment-naive eyes (compared with those on only biologics) were associated with a significant decrease in both DCP whole-image and extra-FAZ VD. Increasing disease duration was associated with a significant decrease in both SCP whole-image and extra-FAZ VD. Longitudinal analysis demonstrated no significant difference in any vessel analysis parameters except for an increase in DCP FAZ area.

Our results demonstrate a significant a decrease in VD in BCR eyes and an association on multivariable analysis with disease duration. Quantifying VD in the retinal microvasculature may be a useful biomarker for monitoring disease severity and progression in patients with BCR. Further studies with extended longitudinal follow-up are needed to characterize its utility in monitoring disease progression and treatment response.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Figures