274. Fundus Fluorescein Angiography – a Valuable Adjunct to Diagnosis and Monitoring in Systemic Autoimmune Disease?
Creators: name: Brona Dinneen1
name: Stack1, John
name: Rodgers2, Duncan
name: McCarthy1, Geraldine
name: Donnelly1, Suzanne
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background: </strong>Systemic autoimmune disease (SAD) is often associated with ophthalmic signs and symptoms. Ophthalmic symptoms of retinal vasculitis are often nonspecific. Fundus fluorescein angiography (FFA) can be a useful adjunct in objective assessment and aid in reaching a diagnosis or monitoring response to therapy. FFA features of retinal vasculitis and anterior ischemic optic neuropathy (AION) include retinal arterial leakage and sheathing, peripher§al capillary drop out, reduced venous perfusion, patchy choroidal filling and increased arm to eye time. Here we present a case series illustrating the utility of FFA in monitoring and diagnosing a variety of SAD. <strong>Methods:</strong> We retrospectively describe a case series in which FFA was used in the diagnosis and / or monitoring of SAD with visual involvement. All patients were attending the Rheumatology and Ophthalmology department at the Mater Misericordiae University Hospital (MMUH), Dublin between May-October 2021. All data was anonymised and patient consent was granted for their information to be presented and published as an abstract. <strong>Results:</strong> We identified 4 patients with a variety of SAD in whom defining the nature and extent of visual symptoms and retinal vasculitis proved challenging or in whom FFA provided additional diagnostic utility. Case1: 75-year-old female with biopsy proven giant cell arteritis (GCA) diagnosed in 2016 re-presented with recurrence of headache but no other signs or symptoms of active GCA. Inflammatory markers were normal. FFA showed an enlarged foveal avascular zone and patchy choroidal filling suggestive of imminent AION. Given the FFA findings, the patient was treated as a GCA relapse. Her corticosteroid dose was increased with subsequent resolution of her FFA finding. Case 2: 43-year-old female with SLE who presented with acute painless monocular visual loss. MRI brain showed non-specific white matter changes and lumbar puncture was bland. FFA demonstrated loss of capillary bed in the temporal periphery with adjacent abnormal vasculature. These findings were consistent with AION with bilateral posterior segment peripheral ischemia at the level of the capillary beds. FFA was repeated at 3 months following initiation of immunomodulatory therapy and showed no interval change, indicating stable disease. Case 3: 19-year-old male presented with a 4 day history of headache, bloodshot eyes, photophobia and reduced vision in both eyes. CRP was 105mg/L and ESR 77mm/hr. He had bilateral acute anterior uveitis and was prescribed topical steroids. He complained of bilateral flashing field defects. His retinal exam was normal. FFA showed bilateral occlusion of his capillary beds in the peripheral temporal retina. The FFA confirmed a panuveitis. He subsequently developed inflammatory lower back pain and was diagnosed with axial spondyloarthropathy and commenced on anti-TNF therapy. Case 4: 49-year-old female presented with gradual onset inferior quadrantanopia in the setting of a weak positive MPO-ANCA and no other clinical or laboratory features of systemic vasculitis. Retinal exam revealed inferiorly swollen optic discs. The working differential diagnosis was AION secondary to MPO-ANCA vasculitis vs non-arteritic ischaemic optic neuropathy (NAION) secondary to anatomical anomaly of the optic discs. Monitoring via FFA has shown resolution of disc leakage following steroid treatment inferring an AION and commencement of systemic immunosuppression. <strong>Conclusions:</strong> These cases illustrate the potential utility of FFA in the diagnosis and monitoring of patients with SAD and ocular involvement. Ophthalmic symptoms of SAD are often mild, and patients find them difficult to describe. FFA allows detection and monitoring of subclinical or overt manifestations of SAD. FFA also allows delineation of the type and level of vascular bed affected. Further research is needed to validate the utility of FFA in diagnosing and monitoring SAD with eye involvement. <strong>Disclosures:</strong> No disclosures <strong>Figure 1.</strong> 1a Patient fundus (normal) 1b Normal FFA 1c Patient FFA (abnormal) red arrows to area of leakage 1a 1b 1c