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

Eye volume 39, pages 2645–2654 (2025)Cite this article

Subjects

Abstract

Purpose

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

Methods

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.

Results

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).

Conclusions

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

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Fig. 1: Various configurations of Dark Without Pressure retinopathy and its appearance on multimodal imaging.
Fig. 2: Multimodal Imaging demonstrating evolution of Dark Without Pressure retinopathy in patient with retinal vasculitis.
Fig. 3: Multimodal Imaging showing appearance and improvement in Dark Without Pressure retinopathy after improvement in vascular leakage.

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Data availability

Data can be made available upon reasonable request after removing appropriate patient identifiers.

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Funding

An unrestricted grant from Research to Prevent Blindness, National Eye Institute, P30-Ey026877.

Author information

Authors and Affiliations

  1. Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA

    Cigdem Yasar, Hashem Ghoraba, Christopher Or, Amir Akhavanrezayat, Jonathan Regenold, Sungwho Park, Hassan Khojasteh, Muhammad Sohail Halim, Irmak Karaca, Brandon Huy Pham, Gunay Uludag, Wataru Matsumiya & Quan Dong Nguyen

  2. Cincinnati Eye Institute/University of Cincinnati, Cincinnati, USA

    Muhammad Hassan

  3. Pusan National University Hospital, Busan, South Korea

    Sungwho Park

  4. Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Wataru Matsumiya

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  1. Cigdem Yasar
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Contributions

Çigdem Yasar: Initial observations and hypothesis development, methodology, data collection, image analysis, data analysis, interpretation, writing the original draft, reviewing, and revisions. Muhammad Hassan: Reviewing and writing the original and revised manuscript, methodology, data interpretation, and analysis. Hashem Ghoraba: Manuscript review and methodology. Christopher Or: Manuscript review and image analysis-software support. Amir Akhavanrezayat: Manuscript review and image preparation. Jonathan Regenold: Manuscript review. Sungwho Park: Manuscript review. Hassan Khojasteh: Manuscript review. Muhammad Sohail Hali: Manuscript review and image analysis. Irmak Karaca: Manuscript review. Brandon Huy Pham: Manuscript review. Gunay Uludag: Manuscript review. Wataru Matsumiya: Manuscript review. Quan Dong Nguyen: Manuscript review.

Corresponding author

Correspondence to Quan Dong Nguyen.

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Yasar, C., Hassan, M., Ghoraba, H. et al. Multimodal imaging of dark without pressure lesions in paediatric retinal vasculitis: A cross-sectional study. Eye 39, 2645–2654 (2025). https://doi.org/10.1038/s41433-025-03882-3

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