Multimodal imaging of dark without pressure lesions in paediatric retinal vasculitis: A cross-sectional study

To assess relationship between dark without pressure (DWP) retinopathy and retinal vasculitis (RV) in paediatric uveitis patients.

This is a retrospective cross-sectional study. Wide angle fundus photographs (WAFP), fundus autofluorescence (FAF), and optical coherence tomography (OCT) images were analysed to identify DWP retinopathy. Confluent dark areas on WAFP, hypo-autofluorescence on FAF, and EZ disruption on OCT images were the markers for DWP. DWP retinopathy area was measured using Image-J. The prevalence and characteristics of DWP in RV patients and its association with RV was reported.

Out of 43 paediatric uveitis patients, 26 were diagnosed with RV. Amongst these, DWP was detected in 20 patients (30 eyes) which were analysed. Mean age was 12.8 ± 3.36 years; 40% were female. DWP areas were either diffuse, mid-peripheral or peripheral on WAFP. All 20 patients (30 eyes) showed hypo-autofluorescence on FAF at the same locations as the WAFP. The mean duration of follow-up was 27.2 ( ± 13.7) months. 12 patients (19 eyes) who had DWP at baseline visit had longer duration of uveitis compared to 8 patients (11 eyes) who developed DWP on follow-up visits (p < 0.036). Progression of the retinopathy overtime was analysed in 28 eyes; all eyes showed improvement of RV with therapy. There was a statistically significant relationship between change in vascular leakage and the change in DWP retinopathy area (chi square= 11.67, p = 0.001).

DWP can potentially serve as a biomarker of RV in paediatric uveitis patients and its presence should warrant WAFA evaluation in this patient population.