Purpose

To analyse the clinical characteristics associated with fern-like leaks on ultra-widefield fluorescein angiography (UWFA)

Methods

Retrospective review of clinical records of eyes presenting with fern-like leakage on UWFA. Clinical and imaging characteristics were compared between eyes with Behcet’s and non-Behcet’s etiology.

Results

67 eyes of 36 patients were included in the study. There were 23 (63.88%) males and 13 (36.11%) females, with a mean age of 26.24+/-12.31 years. Vasculitis was bilateral in 31 (86.11%) and unilateral in 05 (13.8%) patients. 23 eyes of 12 patients had Behcet's disease & 44 eyes of 24 patients in the non-Behcet’s group included: tubercular vasculitis (33 eyes), tubulointerstitial nephritis (09 eyes), and autoinflammation, antibody deficiency, and immune dysregulation (APLAID) syndrome (02 eyes). The fern-like leak was seen in the posterior pole and periphery in all eyes with no involvement of a large vessel. The features compared between Bechet’s and Non-Bechet’s groups were: unilateral/bilateral involvement (nil vs 20.8%); staining of perivascular choroiditic scars (nil vs 22.70%); retinitis (17.40% vs nil); capillary non-perfusion areas (13% vs 25%); disc hyperfluorescence (52.2% vs 25%); neovascularisation of the optic disc (4.30% vs nil); nil vs 2.30%); and cystoid macular edema (34.8% vs 27.30%). Staining of choroiditic scars (10/44 eyes) and unilaterality (05/24 patients) was associated with non-Bechet’s etiology (p value 0.05), whereas the presence of retinitis (04/23 eyes) and disc hyperfluorescence (12/23 eyes) indicates Bechet’s disease (p value 0.05).

Conclusions

Fern like leakage suggestive of small vessel vasculitis can be seen in both Bechet’s as well as Non-Behcets’s etiologies. Presence of retinitis and disc hyperfluorescence on fundus fluorescein angiography indicates Bechet’s disease whereas the staining of choroiditic scars and unilaterality is associated with Non-Bechet’s etiology.