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Assessment of measurement methods of posterior inflammation in stromal choroiditis: the value of quantitative outcome measures versus the presently qualitatively based paradigm

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Abstract

Purpose

To assess posterior inflammation using a fluorescein (FA)/indocyanine-green angiography (ICGA) scoring system, and compare them to the presently recommended outcome measure, the standardization of uveitis nomenclature vitreous haze score (SUN-VH) in stromal choroiditis.

Methods

This was a retrospective study on patients with a diagnosis of ocular sarcoidosis(OS), ocular tuberculosis(OT), Birdshot retinochoroiditis(BRC) and Vogt–Koyanagi–Harada disease(VKH) seen in the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. Angiography signs were quantified according to an established FA/ICGA scoring system. Vitritis was assessed using SUN-VH. Results were compared.

Results

65 newly diagnosed patients (128 eyes) with stromal choroiditis were included. Angiographic scoring showed variable degrees of choroidal versus retinal involvement (87% for OS, 72% for OT, 62.5% for BRC and 100% for VKH). On the other hand, a mere 22 of 128 eyes (17%) showed a SUN-VH score ≥ 2 necessary for inclusion in clinical trials. Moreover, FA/ICGA values followed a normal distribution curve and presented inter-examiner variations greater than 1-SD in only 8.4% of cases. SUN-VH values’ distribution was non-normal and showed inter-examiner discrepancies greater than 1-SD in 51.7% of cases.

Conclusion

This study highlights the precise measurement of global posterior inflammation achieved by a dual FA/ICGA scoring system in stromal choroiditis. In contrast, SUN-VH scale appears imprecise and inadequate, as only a minute percentage of the studied eyes could have been included in a clinical trial based on this criterion. To evaluate posterior intraocular inflammation meaningfully in stromal choroiditis, the use of dual FA/ICGA is strongly advised and should replace the presently recommended SUN-VH system.

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Authors and Affiliations

  1. Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, 1003, Lausanne, Switzerland

    K. Gillmann, A. El Ameen, R. Massy, F. Fabro, A. Gasc & C. P. Herbort Jr.

  2. Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland

    C. P. Herbort Jr.

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  1. K. Gillmann
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  2. A. El Ameen
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  3. R. Massy
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  4. F. Fabro
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  5. A. Gasc
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  6. C. P. Herbort Jr.
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Correspondence to C. P. Herbort Jr..

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All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Gillmann, K., El Ameen, A., Massy, R. et al. Assessment of measurement methods of posterior inflammation in stromal choroiditis: the value of quantitative outcome measures versus the presently qualitatively based paradigm. Int Ophthalmol 39, 1567–1574 (2019). https://doi.org/10.1007/s10792-018-0979-y

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  • DOI: https://doi.org/10.1007/s10792-018-0979-y

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