Macular retinal and choroidal thickness in unilateral relentless placoid chorioretinitis analyzed by swept-source optical coherence tomography
© Dolz-Marco et al.; licensee Springer. 2014
Received: 20 May 2014
Accepted: 25 August 2014
Published: 2 October 2014
The purpose of this study is to evaluate the retinal and choroidal thickness of the macular region in patients with unilateral relentless placoid chorioretinitis (RPC) and macular involvement. Patients diagnosed with RPC affecting only one eye underwent a comprehensive ophthalmologic examination including best-corrected visual acuity (BCVA), axial length (AL) measurement, slit-lamp examination, and color fundus and autofluorescence photography. The macular region was scanned by swept-source optical coherence tomography in the 1,050-nm wavelength. Automated segmentations of the retina and the choroid were used to obtain the corresponding thickness values.
A total number of three patients (two men and one woman; age range 17 to 62 years) were included. Eyes with clinically evident RPC had a mean AL of 24.62 - 0.11 mm, whereas in the clinically healthy fellow eyes, the mean AL was 24.65 - 0.03 (p?=?0.70). The mean BCVA was 0.93 - 0.16 in eyes with RPC, and 1.0 in all the fellow eyes (p?=?0.70). Slit-lamp examination did not reveal any sign of vitreous inflammation in any cases. The mean macular retinal thickness was 288.10 - 10.22 ?m in eyes with RPC, and 300.30 - 7.17 ?m in the healthy fellow eyes (p?=?0.20). The mean central choroidal thickness was 260.70 - 140.60 ?m in eyes with RPC, and 262.30 - 123.10 ?m in the fellow eyes (p?=?0.99). The mean macular choroidal thickness was 248.60 - 128.40 and 255.10 - 123.60 ?m, respectively (p?=?0.99).
The pathogenesis of RPC remains unknown. No changes in the retinal and choroidal thickness were observed in the macular area of eyes diagnosed with RPC with macular involvement compared with the asymptomatic healthy fellow eyes. Further prospective studies are warranted in order to investigate the role of the choroid in cases of RPC.
KeywordsChoroidal thickness Uveitis Relentless placoid chorioretinitis Swept-source OCT
Relentless placoid chorioretinitis (RPC), also known as ampiginous choroiditis, was first described by Jones et al. as a particular type of posterior uveitis that shared clinical and angiographic characteristics with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis. However, it typically exhibits a prolonged clinical course, with recurrences of the inflammation after months to years following the onset -. The scattered distribution of the multiple, plaque-like, creamy coalescent lesions, affecting simultaneously the posterior pole and the midperipheral retina, usually leads to poor visual outcomes .
The etiopathogenesis of RPC remains unknown, but both fluorescein and indocyanine green angiographic findings evidence involvement of the choroid altogether with the typical retinal changes . The analysis of the choroidal morphologic and morphometric features has significantly improved with the development of high-penetrance optical coherence tomography (OCT) devices ,. The last generation of these integrates the swept-source (SS) laser technology. The SS-OCT is characterized by a light source with a longer wavelength of 1,050 nm. This technical change allows deeper penetration through the ocular tissue, thus obtaining a three-dimensional (3D) high-contrast image of the retina and the choroid ,. This system has a scanning speed of 100,000 A-scans per second and a scan window depth of 2.6 mm with an axial resolution of 8 mm and a transverse resolution of 20 mm in tissue . In the present study, we evaluated the choroidal thickness of the macular area in patients with unilateral RPC and macular involvement.
This observational retrospective study evaluated patients diagnosed with macular involvement due to unilateral RPC by a single physician (RGP) according to the previous reports on this disease -. The present study was conducted in accordance with the principles of the Declaration of Helsinki and in compliance with the La Fe University and Polytechnic Hospital review board and informed consent regulations.
All the data were processed and a comparison between the data of the affected eye and the fellow healthy eye was performed. Statistical analysis was performed using Statistical Package for Social Sciences v.20.0 (IBM Corp., Armonk, NY, USA).
Quantitative analysis of the retina
Mean retinal thickness values per sector
Quantitative analysis of the choroid
Mean choroidal thickness values per sector
The differential diagnosis of RPC includes mainly APMPPE and serpiginous choroiditis. These diseases share similar clinical and angiographic characteristics, with creamy lesions that exhibit early hypofluorescence in the fluorescein angiography with later staining . The different clinical course and the atypical distribution of the lesions in patients with RPC may assist its diagnosis, although some cases may need a long-term follow-up to be able to differentiate them.
The angiographic characteristics in patients with acute RPC reveal a presumed choroidal involvement, which represent a common finding in cases of posterior uveitis. Changes in the choroidal thickness have been reported in many inflammatory diseases as Vogt-Koyanagi-Harada disease , Beh et uveitis  or posterior scleritis . To the best of our knowledge, there are no reports in the literature regarding the influence of RPC, APMPPE, or serpiginous choroiditis in the choroidal tissue.
We studied the retinal and choroidal thickness of the macula in cases of unilateral RPC with macular involvement in a quiescent stage. Our results did not evidence any difference in the retinal or choroidal thickness in the macular area when comparing the affected eye with the fellow healthy eye. We hypothesized that this characteristic may help in the differential diagnosis with serpiginous choroiditis, since cases of serpiginous choroiditis may lead to severe atrophic legacy not only in the retina but also in the choroid. This relative sparing of the choroid in RPC may be related to the degree of the inflammatory reaction on the tissue.
The limitations of our study include the short number of patients and follow-up. There is also a lack of reports regarding the choroidal thickness in cases of posterior uveitis. Further studies are warranted in order to confirm the sparing of the choroidal thickness in cases of RPC. These data might be useful in the differentiation of plaque-like white dot syndromes as RPC, APMPPE, and serpiginous choroiditis.
Acute posterior multifocal placoid pigment epitheliopathy
Standard early treatment of diabetic retinopathy study
Optical coherence tomography
Relentless placoid chorioretinitis
We thank Nestor Garca Marn for his valuable help in the examination of patients and Dr. M Dolores Pinazo Durn for the evaluation and critical analysis of the study design.
- Jones BE, Jampol LM, Yannuzzi LA, Tittl M, Johnson MW, Han DP, Davis JL, Williams DF: Relentless placoid chorioretinitis: a new entity or an unusual variant of serpiginous chorioretinitis? Arch Ophthalmol 2000, 118: 931–938. 10.1001/archopht.118.4.584View ArticlePubMedGoogle Scholar
- Veronese C, Marcheggiani EB, Tassi F, Pichi F, Morara M, Ciardella AP: Early autofluorescence findings of relentless placoid chorioretinitis. Retina 2014, 34: 625–627. 10.1097/IAE.0b013e3182a487d5View ArticlePubMedGoogle Scholar
- Yeh S, Lew JC, Wong WT, Nussenblatt RB: Relentless placoid chorioretinitis associated with central nervous system lesions treated with mycophenolate mofetil. Arch Ophthalmol 2009, 127: 341–343. 10.1001/archophthalmol.2009.12View ArticlePubMedGoogle Scholar
- Choma M, Sarunic M, Yang C, Izatt J: Sensitivity advantage of swept source and Fourier domain optical coherence tomography. Opt Express 2003, 11: 2183–2189. 10.1364/OE.11.002183View ArticlePubMedGoogle Scholar
- Unterhuber A, Povazay B, Hermann B, Sattmann H, Chavez-Pirson A, Drexler W: In vivo retinal optical coherence tomography at 1040 nm - enhanced penetration into the choroid. Opt Express 2005, 13: 3252–3258. 10.1364/OPEX.13.003252View ArticlePubMedGoogle Scholar
- Agawa T, Miura M, Ikuno Y, Makita S, Fabritius T, Iwasaki T, Goto H, Nishida K, Yasuno Y: Choroidal thickness measurement in healthy Japanese subjects by three-dimensional high-penetration optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2011, 249: 1485–1492. 10.1007/s00417-011-1708-7View ArticlePubMedGoogle Scholar
- Hirata M, Tsujikawa A, Matsumoto A, Hangai M, Ooto S, Yamashiro K, Akiba M, Yoshimura N: Macular choroidal thickness and volume in normal subjects measured by swept-source optical coherence tomography. Invest Ophthalmol Vis Sci 2011, 52: 4971–4978. 10.1167/iovs.11-7729View ArticlePubMedGoogle Scholar
- Nakayama M, Keino H, Okada AA, Watanabe T, Taki W, Inoue M, Hirakata A: Enhanced depth imaging optical coherence tomography of the choroid in Vogt-Koyanagi-Harada disease. Retina 2012, 32: 2061–2069. 10.1097/IAE.0b013e318256205aView ArticlePubMedGoogle Scholar
- Kim M, Kim H, Kwon HJ, Kim SS, Koh HJ, Lee SC: Choroidal thickness in Behcet's uveitis: an enhanced depth imaging-optical coherence tomography and its association with angiographic changes. Invest Ophthalmol Vis Sci 2013, 54: 6033–6039. 10.1167/iovs.13-12231View ArticlePubMedGoogle Scholar
- Uchihori H, Nakai K, Ikuno Y, Gomi F, Hashida N, Jo Y, Nishida K: Choroidal observations in posterior scleritis using high-penetration optical coherence tomography. Int Ophthalmol 2014,34(4):937–943. doi:10.1007/s10792–013–9894–4 10.1007/s10792-013-9894-4View ArticlePubMedGoogle Scholar
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