Ellipsoid zone recovery following systemic treatment for non-infectious uveitis
Authors: Michael T. Kryshtalskyj, Tina Felfeli, Jeremy Rau, Nupura Bakshi, Larissa A. Derzko- Dzulynsky.
Department of Surgery (Section of Ophthalmology), University of Calgary, 2Department of Ophthalmology and Vision Sciences, University of Toronto, 3Department of Bioengineering, Faculty of Engineering, McGill University.
Author Disclosure Block: M.T. Kryshtalskyj: None. T. Felfeli: None. J. Rau: None. N. Bakshi: None. L.A. Derzko-Dzulynsky: None.
Purpose: The integrity of the retinal ellipsoid zone (EZ) is known to correlate with visual acuity and functional outcome. Uveitis can cause many visually significant retinal changes, which may vary in their reversibility. Using optical coherence tomography (OCT), this study describes recovery of EZ integrity following systemic treatment in eyes with non-infectious uveitis, and identifies clinical features associated with EZ disruption.
Study Design: Retrospective, observational cohort study.
Methods: Charts of 36 patients (69 eyes) with posterior uveitis, panuveitis, and anterior or intermediate uveitis with cystoid macular edema (CME) requiring immunomodulatory or biologic therapy from May 2015 to July 2019 were reviewed. Demographic data, visual acuity, ocular and systemic disease characteristics, and treatments were recorded. OCT images were graded and confirmed by a second independent reviewer. Disruption of the EZ was defined as any irregularities of that layer on OCT - in reflectivity, thickness, or continuity. Descriptive and analytical statistics were performed with significance defined as p<0.05.
Results: Of 69 uveitic eyes, 7 (10%) had disruption of the EZ. 100% of eyes with EZ disruption had subsequent restoration of EZ architecture after quiescence was achieved; median time to recovery was 5 months with high variability (range 1-16 months). Two eyes had recurrence of EZ disruption with subsequent flares. Three eyes had restoration of the EZ within 2 months on oral prednisone. Four eyes had restoration of the EZ between 5 and 16 months after quiescence was achieved using combinations of oral prednisone, methotrexate, mycophenolate mofetil, and infliximab or adalimumab infusions. At onset of EZ disruption, comorbid OCT findings included retinal pigment epithelium hyperreflectivity or irregularities (n=4), epiretinal membrane (n=4), absence of foveal concavity (n=4), atrophy or retinal
disorganization (n=3), CME (n=3), subretinal fluid (n=1) and vitreomacular adhesion (n=1). While not statistically significant, LogMAR visual acuities were worse in the disrupted EZ group than the non- disrupted group at initial (0.591 vs. 0.271) and final endpoints (0.593 vs. 0.063).
Conclusions: EZ disruption is relatively uncommon in non-infectious uveitis (posterior, panuveitis, and anterior/intermediate with CME) and can recover anatomically with treatment. Recovery time is highly variable, ranging between 1-16 months.