Peripheral retinal evaluation comparing fundus photographs with fluorescein angiograms in patients with diabetes mellitus.

Abstract

To evaluate peripheral nonproliferative retinopathy by comparing fundus photograph changes with angiographic findings in type 1 diabetic patients with a long duration of diabetes. Thirty-eight patients with type 1 diabetes, without proliferative retinopathy and with at least 30 years of diabetes duration, were selected to be examined with fundus photography and fluorescein angiography. Two levels of retinopathy degree were identified. In fundus photographs, level 1 represented eyes with no or mild peripheral background retinopathy (i.e., five or fewer pinpoint hemorrhages or microaneurysms), and level 2, peripheral moderate retinopathy (i.e., dot-and-blot hemorrhages or intraretinal microvascular abnormalities or cotton-wool spots). In the angiograms, level 1 represented a nearly normal vascular pattern with occasional microaneurysms and level 2 comprised morphologic signs of abnormal circulation such as dilated capillaries, arteriolar abnormalities, intraretinal microvascular abnormalities, and capillary loss of 3 or more disk diameters from the center of the macula. The angiograms and fundus photographs were graded separately and the results of the grading were compared. The peripheral parts of the retina could be visualized with a high photographic quality on both fundus photographs and angiograms in 66 eyes. On fundus photographs, both graders found level 1 retinopathy in 47 of 66 eyes and level 2 retinopathy in 13 of 66 eyes. On angiograms, both graders found level 1 retinopathy in 46 of 66 eyes, whereas level 2 retinopathy was seen in 16 of 66 eyes. In most eyes with no or mild retinopathy, the angiograms were interpreted as nearly normal (41 of 47), and in most eyes with moderate retinopathy, they were interpreted as abnormal (10 of 13). The degree of peripheral diabetic retinal changes based on grading of fundus photographs was comparable to that based on angiograms in 51 of 66 (77%) eyes.