Background/Objectives: To investigate the rate of exudative progression over time in patients with non-exudative macular neovascularization (NE-MNV) associated with various acquired macular degenerations presenting with a double-layer sign (DLS) or triple-layer sign (TLS) on optical coherence tomography (OCT), and to identify potential predictors of this progression. Methods: Fifty-one eyes of fourty-nine patients with a DLS or TLS on OCT images were identified. OCT angiography (OCTA) was performed to detect NE-MNV, and only eyes with confirmed NE-MNV were included in the final analysis. Central macular thickness (CMT), choroidal thickness (CT), morphology of the abnormal vessels, the duration of follow-up, progression to active exudative MNV, and the status of the contralateral eye were assessed. Results: The final analysis included 32 eyes of 30 participants with NE-MNV. The median observation period was 46 months. The causes of NE-MNV were age- related macular degeneration (AMD) in 59.38% of eyes, pachychoroid epitheliopathy (PPE) in 37.50%, and other causes in 3.12%. Exudation developed in 15.62% of eyes (median time to onset: 24 months), predominantly in the AMD subgroup. Abnormalities in the fellow eye were present in 59.38% of cases. Neither age nor other factors, including sex, cause of MNV, CMT, CT, MNV morphology, or fellow eye status, were statistically significant predictors of progression to active MNV (p = 0.67, p > 0.99, p = 0.62, p = 0.09, p = 0.09, p = 0.2, p = 0.62, resp.). Conclusions: NE-MNV is an asymptomatic condition that may occur in the course of various retinal diseases. While DLS and TLS demonstrate high sensitivity and specificity for the diagnosis of NE-MNV, their presence does not always indicate concurrent MNV. Multimodal imaging is essential for accurate monitoring of these patients and detection of potential disease progression.

Background: To investigate the effects of biologic and targeted synthetic therapies on retinal microvascular parameters assessed by optical coherence tomography angiography (OCTA) in patients with axial spondyloarthritis (axSpA). Methods: This cross-sectional study included 159 eyes of 82 patients with radiographic or non-radiographic axSpA receiving tumor necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i), or Janus kinase inhibitors (JAKi) for at least one year. All patients had low disease activity at the time of examination (BASDAI < 3). Comprehensive ophthalmic evaluation and swept-source OCTA imaging were performed. The superficial capillary plexus vessel density and foveal avascular zone (FAZ) areas in both the superficial (SCP) and deep capillary plexus (DCP) were assessed. Statistical analyses were adjusted for age, sex, smoking status, history of uveitis, treatment duration, and ocular variables. Results: Significant differences were observed among treatment groups in the deep foveal avascular zone (DCP-FAZ) area (P = 0.0060). Post-hoc analyses revealed larger DCP-FAZ values in patients treated with TNFi compared with IL-17i (P = 0.0010), and in those treated with IL-17i compared with JAKi (P = 0.0151). No significant differences were found in superficial FAZ area or superficial capillary plexus vessel density between treatment groups. Patients receiving JAKi were older and had shorter treatment duration compared with the other groups. Smoking status was associated with a significantly smaller deep FAZ area (P = 0.0019), whereas superficial FAZ measurements remained unaffected. A weak positive correlation was observed between intraocular pressure and deep FAZ area (r = 0.18, P = 0.0237), and treatment duration was positively correlated with deep FAZ size (rho = 0.16, P = 0.0454). Conclusions: Different classes of biologic and targeted synthetic therapies are associated with distinct retinal microvascular characteristics in patients with axSpA. The observed differences in deep FAZ measurements suggest that treatment-specific effects on retinal microcirculation may persist despite low systemic disease activity. OCTA may serve as a valuable non-invasive tool for detecting subclinical vascular alterations and monitoring ocular microvascular involvement in axSpA. Further longitudinal studies are required to clarify the clinical significance and long-term implications of these findings.

Background: To compare retinal microvascular parameters assessed by optical coherence tomography angiography (OCTA) among patients with axial spondyloarthritis (axSpA) receiving different biologic and targeted synthetic therapies and to evaluate the association between smoking status and OCTA-derived retinal microvascular parameters. Methods: This cross-sectional study included 159 eyes of 82 patients with radiographic or non-radiographic axSpA receiving tumor necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i), or Janus kinase inhibitors (JAKi) for at least one year. At the time of examination, all patients had BASDAI scores below the established threshold for active disease (BASDAI < 4). Comprehensive ophthalmic evaluation and swept-source OCTA imaging were performed. Superficial capillary plexus vessel density and foveal avascular zone (FAZ) areas in both the superficial (SCP) and deep capillary plexus (DCP) were assessed. Statistical analyses were adjusted for age, sex, smoking status, history of uveitis, treatment duration, and ocular variables. Results: Significant differences were observed among treatment groups in the deep foveal avascular zone (DCP-FAZ) area (p = 0.0060). Post hoc analyses demonstrated larger DCP-FAZ values in patients receiving TNFi than in those receiving IL-17i (p = 0.0010), and larger values in the IL-17i group than in the JAKi group (p = 0.0151). No significant differences were observed in superficial FAZ area or superficial capillary plexus vessel density between treatment groups. Patients receiving JAKi were older and had a shorter treatment duration than those in the other groups. Smoking status was associated with a significantly smaller deep FAZ area (p = 0.0019), whereas no significant association was observed for superficial FAZ measurements. A weak positive correlation was found between intraocular pressure and deep FAZ area (r = 0.18, p = 0.0237), and treatment duration was weakly positively correlated with deep FAZ area (rho = 0.16, p = 0.0454). Conclusions: Retinal microvascular parameters differed among patients with axSpA receiving different classes of biologic and targeted synthetic therapies. Differences were observed primarily in the deep FAZ area, while smoking status was also associated with deep retinal microvascular parameters. Because of the cross-sectional design, these findings should be interpreted as associations rather than evidence of treatment effects. OCTA may provide a useful non-invasive method for assessing retinal microvascular characteristics in patients with axSpA. Further longitudinal studies are warranted to clarify the relationship between systemic therapies, smoking status, and retinal microvascular changes.

Axial spondyloarthropathy (axSpA) belongs to a group of chronic, progressive inflammatory diseases with a variety of clinical manifestations, including musculoskeletal and extra-articular symptoms. The most common extra-articular manifestation in patients with axSpA is uveitis, which usually involves the anterior segment, can be recurring, and is a vision-threatening complication. Ocular complications can result from the disease itself, as well as from the therapy used to treat it. Treatment for axSpA is based on both pharmacological and non-pharmacological management. Biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) are an effective and constantly evolving form of axSpA therapy; however, their application and side effects remain under study. The aim of this article is to summarize current knowledge about the efficacy of biologic and targeted synthetic DMARDs in non-infectious uveitis in axSpA and delineate their effect on the organ of vision.