Fluorescein Angiographic Findings Research Articles

Unusual clinical phenotype of Stargardt disease

Mutations in the ABCA4 gene are a common cause of Stargardt disease; however, other retinal phenotypes have also been associated with mutations in this gene. We describe an observational case report of an unusual clinical phenotype of Stargardt disease. The ophthalmological examination included best corrected visual acuity, color and autofluorescence photography, fluorescein angiography, optical coherence tomography, and electrophysiology tests. Targeted next-generation sequencing of 99 genes associated with inherited retinal dystrophies was performed in the index patient. A 48-year-old woman presented with a best corrected visual acuity of 20/25 and 20/20. Fundoscopy revealed perifoveal yellow flecked-like lesions. Fluorescein angiography and fundus autofluorescence findings were consistent with pattern dystrophy. Pattern electroretinogram demonstrated bilateral decrease of p50 values. Genetic testing identified two heterozygous missense mutations, c.428C>T, p.(Pro143Leu) and c.3113C>T, p.(Ala.1038Val), in the ABCA4 gene. Based on our results, we believe that these particular mutations in the ABCA4 gene could be associated with a specific disease phenotype characterized by funduscopic appearance similar to pattern dystrophy. A detailed characterization of the retinal phenotype in patients carrying specific mutations in ABCA4 is crucial to understand disease expression and ensure optimal clinical care for patients with inherited retinal dystrophies.

Impact of serous macular detachment on visual recovery in retinal vein occlusion treatment.

The aim of this study was to evaluate the effect of serous macular detachment observed during retinal vein occlusion on treatment results. A total of 117 eyes from 115 patients who had been treated with intravitreal injections for macular edema secondary to retinal vein occlusion were retrospectively reviewed. Visual acuity, optical coherence tomography, and fundus fluorescein angiography findings were evaluated according to the status of serous macular detachment. In the branch retinal vein occlusion group, a statistically significant increase was detected in the mean visual acuity compared to the baseline value at each visit in the absence of serous macular detachment, whereas the increase in the mean visual acuity was significant only at the 3- and 6-month visits in the presence of serous macular detachment. In the central retinal vein occlusion group, there was an increase in the mean visual acuity compared to the baseline value at every visit in the absence of serous macular detachment, whereas the mean visual acuity decreased compared to the baseline value at every visit except at the 3-month visit in the presence of serous macular detachment. The ellipsoid zone defect was more prominent in the presence of serous macular detachment in eyes with branch retinal vein occlusion, whereas there was no significant difference in the ellipsoid zone in the absence or presence of serous macular detachment in eyes with central retinal vein occlusion. In the group with macular edema due to retinal vein occlusion, the initial mean visual acuity increase observed in the first year was maintained in cases without serous macular detachment but not in those with serous macular detachment. Serous macular detachment could be a negative factor in eyes with retinal vein occlusion.

Ultra-widefield Fluorescein Angiography Findings in Patients with Multiple Retinal Holes

Ultra-widefield Fluorescein Angiography Findings in Patients with Multiple Retinal Holes

Multimodal Imaging in a Long-standing Case of Pattern Dystrophy

Purpose: The aim of this study is to report the case of a patient diagnosed with butterfly pattern dystrophy (BPD), which during yearly follow-up visits developed a concomitant pachychoroidal neovasculopathy (PNV). Methods: Case report focusing on the role multimodal imaging in patients with pattern dystrophies (PDs) Case report: We describe a case of a 52-year-old woman,which was initially diagnosed with BPD by fundus examination, fundus autofluorescence and optical coherence tomofraphy findings. Interestingly, during yearly follow-up visits, the presence of a thickened choroid bilaterally associated with the onset of concomitant choroidal neovascularizations (CNVs) in the right eye was made possibile by adopting multimodal imaging, in particular optical coherence tomography angiography. Fluorescein angiography and indocyanine green angiography findings helped us to make the diagnosis of PNV. Conclusion: We described for the first time a case of PD, which after several years progressed to PNV. Hence, we deem that multimodal imaging and in particular optical coherence tomography angiography represent an important diagnostic tool in the management of PDs.

In vivo imaging comparison of unilateral circular retinal plaques in retriever dogs to dysplasia and detachment in the English Springer Spaniel

To compare the scanning laser ophthalmoscopy (SLO), optical coherence tomography (OCT), and fluorescein angiography (FA) findings in retrievers with a single unilateral circular retinal plaque to those of an English springer spaniel with bilateral retinal dysplasia. A retrospective record review identified three dogs with circular retinal plaques that underwent SLO and OCT; in two of the three dogs, FA was also completed. Morphologic changes, lesion measurements, and angiogram characteristics were documented. An English springer spaniel with bilateral retinal dysplasia that had undergone SLO, OCT, and FA was used for comparison. Scanning laser ophthalmoscopy of the retriever dogs revealed circular retinal plaques with a dark periphery located in the tapetal retina. OCT revealed a thickening of the nerve fiber layer corresponding to the circular pattern observed on SLO. Within the circular plaque, the retina was predominantly of normal architecture. FA revealed variable hypofluorescence of both the rim and the center of the circular lesion throughout the early angiogram phases. In the late recirculation phase, small multifocal areas of hyperfluorescence were observed. OCT of geographic retinal dysplasia in the English springer spaniel revealed disorganization of both inner and outer retinal layers, and retinal detachment. Circular plaques observed in the tapetal retina are predominantly formed by a thickening of inner retina, while retinal dysplasia has disorganization of both inner and outer retinal layers. Further etiologic research is needed, including pedigree mapping to determine whether retinal plaques are an acquired or inherited condition.

Late-phase hypercyanescence during indocyanine green angiography for assessment of myopic choroidal neovascularization.

Indocyanine green angiography (ICGA) is a major diagnostic modality but the clinical implications of specific staining patterns in active myopic choroidal neovascularization (mCNV) are unclear. We examined the associations of ICGA cyanofluorescence patterns with disease characteristics and response to an as-needed intravitreal ranibizumab (IVR) treatment regimen among active mCNV patients. Twenty-four subjects with active mCNV treated by IVR were enrolled in this retrospective cohort study. Information from medical records were reviewed, including best corrected visual acuity (BCVA), fluorescein angiography (FA) findings, ICGA cyanofluorescence patterns, and spectral-domain OCT (SD-OCT) results. The CNV lesion size, CNV thickness, and central retinal thickness (CRT) were measured from these images. Two staining patterns were identified on late-phase ICGA images, hypercyanescence (9/24, 37.5%) and non-hypercyanescence (15/24, 62.5%). There were no differences in baseline BCVA, CNV thickness, and CRT between ICGA pattern groups; however, the hypercyanescence group demonstrated a larger CNV lesion size (p = 0.035) and required more IVR injections than the non-hypercyanescence group (2.67 ± 1.58 vs 1.07 ± 0.27, p = 0.016), while the non-hypercyanescence group demonstrated better final BCVA improvement (p = 0.041). Hypercyanescence could be divided into two types, a uniform type and rim type. A pseudopodia-like protrusion of CNV enlargement with a rim-enhanced type hypercyanescence at the protrusion rim was predictive of required retreatment. Hypercyanescence on late-phase ICGA may assist in identifying more active mCNV requiring intensive treatment.

Peripheral Vascular Abnormalities Detected by Fluorescein Angiography in Contralateral Eyes of Patients With Persistent Fetal Vasculature

To describe peripheral retinal vascular abnormalities in the contralateral eyes of patients with unilateral persistent fetal vasculature (PFV). Retrospective medical record review of fluorescein angiography (FA) findings of patients with unilateral PFV. Width of the temporal peripheral avascular retina in contralateral eyes was measured in disc diameters (DD). Vascular abnormalities were described. In 45 included patients, mean width of temporal peripheral avascular areas in contralateral eyes was 1.87 ± 0.71 DD. Forty-three patients (95.6%) had temporal peripheral avascular areas of 1 DD or greater in contralateral eyes, with 16 having temporal peripheral avascular areas of 2 DD or greater. Vessel shunts, vascular tortuosity and dilatation, circumferential vessels, and abnormal capillary beds in the peripheral retina were observed in 23 (51.1%) contralateral eyes of patients with unilateral PFV. PFV patients should undergo careful evaluations of both eyes, preferably with FA, to identify vascular changes that are not visible clinically. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:506-511.].

Preliminary study of ultra-widefield peripheral retinal angiographic patterns in children and its association to the perinatal condition

This preliminary study analyzed the peripheral retinal vascular pattern in children, using ultra-widefield fluorescein angiography, and its association with perinatal conditions. Retrospective review was conducted examining the fluorescein angiographic findings of children with amblyopia (January 2017 to December 2018). We categorized the peripheral vascular patterns into two groups: loop and branching patterns. We investigated differences in these patterns, according to the perinatal condition. Thirty children (9.27 ± 3.41 years old; 47.67% male) were included. An equal number of children had the loop or branching pattern (15:15). The gestational age (GA) in the loop group was significantly shorter than the branching group (32.92 ± 5.62 vs. 36.67 ± 5.63 weeks, p = 0.04). The birth weight of the loop group was significantly lower than the branching group (2.00 ± 1.03 vs. 2.72 ± 0.93 kg, p = 0.03). Gender, age, delivery-type, and visual acuity, were not different between the groups. Lower birth weight and shorter GA were observed in children with the loop pattern. The difference in peripheral retinal vascular patterns, according to birth weight and GA, might be due to the development of immature retinal vessels at birth.

Conserved regression patterns of retinopathy of prematurity after intravitreal ranibizumab: A class effect.

To determine if fluorescein angiographic (FA) findings after intravitreal ranibizumab (IVR) for retinopathy of prematurity (ROP) conform to a class effect previously described with bevacizumab. Single-center retrospective case series of all infants treated with 0.2 mg (0.02 mL) IVR for Type 1 ROP from July 2016 to November 2018. FA were obtained at 40, 52, 62, and 72 weeks of postmenstrual age (PMA) using wide-angle photography. FA images were analyzed and the peripheral avascular areas measured with ImageJ using a reference disc diameter (DD). Based on the extent of the avascular area and tortuosity of the retinal vessels all eyes were classified into four categories: complete vascular maturity (vascularization within 2 DD of the ora serrata), VAA (avascular area >2 DD of the ora serrata), VAT (avascular area >2 DD of the ora serrata and posterior tortuosity), and reactivation (recurrence of stage disease). About 13 infants were enrolled and 24 eyes were available in this study. None of the eyes reached complete vascular maturity at an average PMA of 60 weeks, 7 (29%) eyes presented with VAA, 8 (33%) with VAT, and 9 (37.5%) reactivated. The reactivated eyes presented with the largest area of peripheral ischemia, followed by the VAT and then the VAA groups (p = 0.02). IVR conforms to the previously described regression patterns following intravitreal bevacizumab for ROP indicative of a class effect. Follow-up using FA might help to optimize the management of these infants after injection of the drug.

Ultra-widefield fundus fluorescein angiography findings in patients with ankylosing spondylitis experiencing uveitis.

To evaluate ultra-widefield fundus fluorescein angiography (FFA) findings in cases of ankylosing spondylitis (AS)-associated uveitis. Forty-five eyes of 23 AS patients followed up with a diagnosis of uveitis were included. Sixteen (69.6%) men and seven (30.4%) women with a mean age of 46.26 ± 10.87 years were included in the study. Retinal vascular leakage was observed in 19 (42.2%) eyes at FFA, diffuse in six (13.3%) and peripheral in 13 (28.9%) eyes. Active anterior uveitis attack was present in seven (36.8%) eyes with vascular leakage at FFA, while no active uveitis findings were present in 12 (63.15%) eyes. No statistical relation was determined between peripheral and diffuse leakage and active uveitis (p = 0.195). No significant association was also determined between both diffuse and peripheral leakage and visual acuity (p = 0.066). We observed widespread retinal vascular leakage at UWF angiography in AS patients (in eyes undergoing active uveitis attacks and inactive eyes).

Fundus fluorescein angiography and optical coherence tomography findings in ocular and non-ocular Behҫet’s disease

Aim of the workThis study aimed at early detection of fundus fluorescein angiography (FFA) findings and optical coherence tomography (OCT) changes denoting active posterior uveitis in Behçet’s Disease (BD) patients before they are clinically evident. Patients and methodsThis study included 50 BD patients subgrouped according to ocular involvement into ocular and non-ocular Behçet patients. All patients underwent thorough ophthalmological examination. Fundus examination was done to detect signs of intermediate and/or posterior uveitis. OCT conventional and enhanced depth techniques were used for assessment of the macular area and choroidal thickness respectively. FFA was done for assessment of retinal vasculature. ResultsThe mean age of the BD patients was 33.26 ± 7.3 years, the disease duration was 8.34 ± 6.6 years and they were 38 males and 12 females. In non-ocular Behçet (n = 25; 49 eyes), 26.5% of eyes showed FFA changes. The mean age at diagnosis in patients showing FFA changes was significantly lower than in those showing no changes (21.08 ± 2.8 years versus 26.53 ± 6.8 years, p = 0.007). There was no significant difference in choroidal thickness between ocular and non-ocular patients (341.4 ± 84.2µ vs 334.24 ± 56.42µ; p = 0.12). In ocular BD (n = 25; 45 eyes: 23 inactive and 22 active) the mean choroidal thickness in patients with uveitic activity was significantly higher than in those with inactivity (377.1 ± 102.9µ versus 307.2 ± 39.9µ, p < 0.0001). ConclusionFFA and OCT are essential and complementary tools for early detection of ocular involvement even before it is clinically evident and for evaluation of the pattern of retinal and choroidal involvement and complications in BD patients.

Rhegmatogenous retinal detachment masquerading as exudative panuveitis with intense anterior chamber inflammatory reaction

PurposeThis is a retrospective case report illustrating the diagnostic and therapeutic challenges associated with a chronic rhegmatogenous retinal detachment masquerading as a severe panuveitis with intense anterior chamber inflammation. We have included clinical features, anterior segment and fundus photography, B-scan ultrasonography, fluorescein angiography, and intraoperative findings. ObservationsA 26-year-old male presented with features of unilateral panuveitis: hypotony, anterior segment inflammation (posterior synechiae and anterior chamber cell with fibrin clumping), diffuse choroidal thickening, and retinal detachment. Laboratory investigations for infectious or rheumatologic processes were negative, and empiric systemic corticosteroid therapy was unsuccessful. This prompted suspicion for an alternate primary etiology, and pars plana vitrectomy revealed small retinal breaks as the underlying cause of the retinal detachment and inflammation. ConclusionsRhegmatogenous retinal detachments are a known cause of intraocular inflammation. Nevertheless, it remains a challenge to recognize retinal breaks in this setting, particularly with robust anterior segment inflammation and posterior findings resembling severe exudative uveitis. Being aware of this unique presentation may prevent delays in diagnosis and have important prognostic implications.

Quantitative Analysis of Ellipsoid Zone in Acute Posterior Multifocal Placoid Pigment Epitheliopathy.

Purpose:Quantitative end points for uveitis are needed. Here we quantify the rate of ellipsoid zone (EZ) recovery on optical coherence tomography (OCT) and correlate it with visual acuity (VA) improvement in patients with acute posterior multifocal placoid pigmented epitheliopathy (APMPPE). We use automated and manually graded EZ area analysis to assess EZ recovery in APMPPE.Methods:We performed a retrospective review of 9 APMPPE cases (18 eyes) that had characteristic clinical examination and fluorescein angiography findings, outer retinal disruption on spectral-domain OCT, and treatment with systemic steroids after an unambiguous laboratory workup. The EZ was delineated using custom software to perform automated analysis and manual grading by 2 independent physicians. Quantitation of EZ changes was performed in ImageJ (National Institutes of Health). EZ maps were compared with equivalent findings from EZ en face OCT segmentation.Results:The 9 cases in our study were followed for an average of 198 days. Symptomatic improvement occurred in all eyes. VA recovery occurred in 83% of eyes and depended on presenting foveal involvement. Positive slopes of EZ area over time demonstrated recovery. EZ recovery profiles determined by manual and automated software demonstrated high Pearson correlation coefficients (0.78-0.94). Slab en face EZ analysis demonstrated moderate agreement.Conclusions:EZ recovery correlates with symptomatic and VA recovery. Automated EZ analysis shows strong agreement with manually graded EZ analysis in APMPPE. EZ recovery in patients with APMPPE provides a biomarker for recovery and may be applied to other diseases affecting the outer retina.

Immune modulator therapy compared with vitrectomy for management of complicated intermediate uveitis: a prospective, randomized clinical study.

To compare the benefits and side effects of pars plana vitrectomy with those of systemic immune modulator therapy for patients with complicated intermediate uveitis. This prospective clinical trial enrolled patients with recurrent intermediate uveitis who exhibited minimal improvement of visual acuity, despite injections of periocular steroids. Twenty patients were randomized to the pars plana vitrectomy group or oral steroid and cyclosporine-A group (10 eyes of 10 patients per group). Follow-up was performed for 24 months to study changes in visual acuity, binocular indirect ophthalmoscopy score, fluorescein angiography, and optical coherence tomography findings. Visual acuity (logarithm of the minimal angle of resolution) significantly improved from 0.71 to 0.42 (p=0.001) in the surgical group, whereas it improved from 0.68 to 0.43 (p=0.001) in the immune modulator therapy group. Seven patients (70%) in the surgical group gained ≥2 lines, and six patients (60%) in the immune modulator therapy group gained ≥2 lines (p=0.970). Fluorescein angiography and optical coherence tomography studies showed that six of seven pars plana vitrectomy patients who had cystoid macular edema experienced improvement, whereas two patients with diffuse macular edema did not experience improvement. In the immune modulator therapy group, three of six patients with cystoid macular edema did not experience improvement, whereas two patients with diffuse macular edema experienced improvement. Pars plana vitrectomy and immune modulator therapy resulted in significant improvement in visual function in patients with persistent inflammation secondary to chronic intermediate uveitis. Despite this success, there remains a need for the determination of optimal indications for the use of each modality. Immune modulator therapy was successful for the treatment of diffuse macular edema associated with chronic intermediate uveitis, whereas pars plana vitrectomy was not.

A clinical study of optical coherence tomography and fundus fluorescein angiography findings in central serous chorioretinopathy with co-relation to visual outcome in a tertiary care center of North-East India

Purpose: The purpose is to identify the characteristic findings of central serous chorio-retinopathy (CSCR) on fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) in a tertiary care center of North-East India and to clinically correlate the final visual outcome with OCT values at the end of 6 months' follow-up. Methodology: A total of 70 cases (77 eyes) of CSCR were taken up for this prospective observational study. Other pathological causes of macular edema were excluded from the study. Visual acuity, OCT, and FFA were done in all cases at day 1 and were followed up till 6 months. OCT was done at each visit. Results: The mean age of the patient was 40 years (range 20–59 years, standard deviation [SD] 11.98). The day 1 mean vision was 0.72 logarithm of the minimum angle of resolution (log MAR), SD 0.30, P

Fluorescein Angiographic Findings of Peripheral Retinal Vasculature after Intravitreal Conbercept versus Ranibizumab for Retinopathy of Prematurity.

Purpose To evaluate angiographic findings of peripheral retina vasculature in retinopathy of prematurity (ROP) neonates who received intravitreal conbercept (IVC) or ranibizumab (IVR). Methods Fluorescein angiography (FA) findings were retrospectively evaluated for ROP neonates who received IVC or IVR. Outcome measures included peripheral avascular zone, vascular leakage, vascular blunting, vascular loops, vascular dilatation, arteriovenous shunt, and capillary dropout. Results Fifty-four eyes (28 patients) with ROP were included. Twenty-nine eyes (15 patients) received IVC, and 25 eyes (13 patients) received IVR. For infants of the IVC group, the mean gestational age, birth weight, and postmenstrual age (PMA) at the initial treatment were 28.96 ± 2.36 weeks, 1168.8 ± 344.5 g, and 41.22 ± 4.39 weeks, respectively. For the IVR group, they were 28.83 ± 2.34 weeks, 1255.0 ± 356.9 g, and 39.42 ± 2.77 weeks, respectively (P=0.817, 0.522, and 0.075). For the IVC group, FA performed at 71.29–115.43 weeks PMA showed 96.55% of eyes had avascular zone; vascular leakage was found in 24.14% eyes; vascular blunting, vascular dilation, vascular loops, arteriovenous shunt, and capillary dropout were found in 96.55%, 72.41%, 79.31%, 48.28%, and 68.97% eyes, respectively. For the IVR group, FA performed at 65.57–133.71 weeks PMA showed 92.0% of eyes had avascular zone; vascular leakage was found in 40.0% eyes; vascular blunting, dilatation, loops, arteriovenous shunt, and capillary dropout were found in 100%, 60.0%, 64.0%, 36.0%, and 68.0% eyes, respectively. Conclusion No significant difference can be observed between the IVC group and IVR group for peripheral vascular structure anomalies with FA evidence. FA studies should be considered to assess the status of the peripheral retinal vasculature to determine therapeutic outcomes and potential functional outcomes.

Novel ultrawide field fundus fluorescein angiographic findings in a patient of Takayasu arteritis on immunosuppression

A 35-year-old male, a case of Takayasu arteritis on treatment with oral prednisolone and methotrexate, revealed novel ultrawide field fluorescein angiographic features in bilateral eyes. The typical features of delayed arm-retina circulation time, lobulated areas of nonperfusion in choroid, cattle trucking of red blood cells in veins, and delayed arteriovenous transit time were nicely captured. Additionally, we noted peripheral perivascular hyperfluorescence and disc hyperfluorescence. We believe these findings could possibly be used as markers of disease activity. Lack of marked capillary nonperfusion areas and marked perivascular leakage probably signifies modulation of disease activity by the immunosuppressants.

Ultra-Widefield Fluorescein Angiography Findings in Patients with Macular Edema Following Cataract Surgery

ABSTRACT Purpose: To evaluate the ultra-widefield fluorescein angiography (UWFA) findings in patients with macular edema (ME) following cataract surgery. Methods: Thirty-three eyes from patients who showed greater than a 30% increase in the central subfield thickness following cataract surgery were included. UWFA scored according to a system suggested by the Angiography Scoring for Uveitis Working Group (ASUWG). Factors associated with a high ASUWG score were evaluated. Results: Thirty-three (100.0%) of the 33 eyes showed abnormal UWFA findings, including optic disc staining (81.8%), capillary leakage (100.0%), pinpoint leakage (84.8%), peripheral retinal vascular leakage (24.2%) and retinal staining (6.1%). Multiple regression analysis reveals that following adjustment for other factors, younger age was independently associated with a higher ASUWG score (R2 = 0.476, p = .001). Conclusions: Patients with ME following cataract surgery show generalized inner and outer blood−retinal barrier breakage. Particular attention is required during cataract surgery in young patients.

Fluorescein angiography findings in both eyes of a unilateral retinoblastoma case during intra-arterial chemotherapy with melphalan.

Fluorescein angiography findings in both eyes of a unilateral retinoblastoma case during intra-arterial chemotherapy with melphalan.

Fluorescein Angiography Findings in Children With Congenital Zika Syndrome.

To evaluate the retinal and vasculature changes in infants with congenital Zika syndrome (CZS) using fluorescein angiography (FA). This consecutive case series included six infants with CZS. FA and color fundus imaging were performed under general anesthesia in both eyes of all infants using a contact widefield digital imaging system. All color fundus images were obtained using a 130° field of view lens, and the FA images were captured using either a 130° or 80° field of view lens. The immunoglobulin M antibody capture enzyme-linked immunosorbent assay was positive for Zika virus in the cerebrospinal fluid samples of all infants. Other congenital infections were ruled out. The mean ± standard deviation age of the infants at the time of examination was 1.4 years ± 0.1 years (range: 1.3 years to 1.5 years). Contact fundus photographs showed macular abnormalities in seven eyes (58%) and retinal vasculature changes in two eyes (17%). FA detected macular abnormalities in all 12 eyes (100%) and retinal vasculature changes in five eyes (42%). The main retinal vasculature changes were peripheral avascularity in five eyes (42%) and microvasculature abnormalities in three eyes (25%). FA may be an important tool for detecting subtle macular and retinal vasculature changes in CZS. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:702-708.].