Fluorescein Angiography in Uveitis: Still a Gold Standard

INTRODUCTION: Despite advances in imaging, color fundus photography remains widely used in the assessment of posterior uveitis, although it provides only structural information. In contrast, fluorescein angiography (FA) allows dynamic visualization of retinal vascular involvement. This study aimed to characterize the use of FA in clinical practice among Portuguese ophthalmologists with experience in ocular inflammation and to assess their ability to predict angiographic abnormalities based solely on fundus photographs. METHODS: A questionnaire with five questions regarding clinical indications for FA in uveitis was sent to Portuguese ophthalmologists experienced in ocular inflammation. A subgroup of these participants also completed a second component in which they were asked to analyse 17 consecutive fundus photographs from patients with uveitis and predict the presence of angiographic abnormalities. RESULTS: Ten responses were obtained regarding FA use in clinical practice. Sixty percent of participants reported that FA is routinely requested at the time of diagnosis in cases of suspected posterior segment involvement. Seventy percent considered segmental or diffuse vascular sheathing to be the funduscopic sign best characterized with FA. Eighty percent used FA as a follow- up tool to monitor clinical response in retinal vasculitis, and 60% reported a preferred follow- up interval of 3 to 6 months. Eight participants completed the image- based component. Full agreement among all ophthalmologists regarding the prediction of FA abnormalities was achieved in only 4 of the 17 cases. The mean prediction accuracy was 64.71%. Focal retinal or choroidal lesions were the easiest to predict, whereas retinal vasculitis was more difficult, with only 32.5% correctly predicting vascular leakage. Peripheral lesions were the most challenging, with 0% correct predictions in two cases. CONCLUSION: FA is considered a valuable diagnostic tool by most ophthalmologists surveyed, both for baseline assessment of posterior uveitis and for follow- up in retinal vasculitis. However, a considerable percentage of clinicians were unable to predict angiographic abnormalities based solely on fundus photographs. These results suggest that FA remains essential in the diagnostic workup of uveitis, as retinal or choroidal changes may go undetected even after careful fundus examination.