Fluorescein Angiographic Patterns Research Articles

High Positive Predictive Value of Fluorescein Angiography Contiguous, Perineural Retinal Vascular Leakage Pattern for Birdshot Chorioretinopathy

ABSTRACT Purpose To determine the sensitivity and positive predictive value (PPV) of a contiguous, perineural retinal vascular leakage fluorescein angiography (FA) pattern in birdshot chorioretinopathy (BSCR) patients. Methods Patients with BSCR and other posterior uveitis/retinal vasculitis and a FA were identified. Two graders reviewed the first FA for leakage primarily around the optic nerve and along the larger arcade vessels. We compared the rates of this pattern in BSCR and non-BSCR patients and calculated sensitivity and PPV. We compared clinical characteristics of BSCR patients with and without this pattern. Results 64 BSCR and 98 non-BSCR patients were identified. The FA pattern’s sensitivity, specificity, and PPV were 57.8%, 91.8%, and 82.2%. This pattern was significantly more common in BSCR patients earlier in their disease (p = .004). Conclusions A contiguous, perineural retinal vascular leakage FA pattern can help identify potential BSCR patients for further testing. This pattern is more common closer to symptom onset.

Prognostic Factor Study of Macular Edema Recurrence in Retinal Vein Occlusion after Conbercept Treatment: A Post Hoc Analysis of the FALCON Study.

Objective The study was aimed at exploring the potential predictive factors associated with the recurrence of macular edema (ME) secondary to vein occlusion (RVO) after intravitreal antivascular endothelial growth factor (VEGF) loading treatment in the FALCON study. Methods This is a post hoc analysis of 30 patients with central RVO and 30 patients with branch RVO. All patients received a monthly administration of intravitreal conbercept during the 3-month loading phase and pro re nata (PRN) treatment during the 6-month follow-up period. Based on the recurrence of ME at the first follow-up visit, patients were classified into the recurrence group or nonrecurrence group. The primary endpoint was to explore the risk factors for recurrence among baseline characteristics, fluorescein angiography (FA) patterns, and optical coherence tomography (OCT). Results In general, 38 patients (64.4%) experienced ME recurrence at the first follow-up visit (3 months), regardless of disease type (p = 0.32). Significant improvements in VA were noted in both the nonrecurrence and recurrence groups (p < 0.001), however, without significant between-group differences (p = 0.1). A significant reduction in CRT in both groups (p < 0.001) was identified, and patients without recurrence showed a greater reduction in CRT compared with those with recurrence (p < 0.001). In addition, logistic regression analyses indicated the corrections of ME recurrence with baseline macular volume and the disruption of the outer limiting membrane at the fovea. Conclusion This study suggested that OCT parameters, including baseline macular volume and outer limiting membrane disruption, and reduction in CRT after loading therapy were more predictive of ME recurrence than FA patterns or visual changes following conbercept loading therapy.

Different Types of Hyperfluorescence Observed in Post Anti-VEGF Fluorescein Angiographic Patterns in Retinopathy of Prematurity Patients

PurposeTo demonstrate that the demographic and treatment characteristics of retinopathy of prematurity (ROP) eyes showed different types of hyperfluorescence in fluorescein angiography (FA) initially treated with anti-vascular endothelial growth factor (VEGF) agents.MethodsA consecutive case series of ROP treated with anti-VEGF agents was retrospectively studied. All the patients underwent FA examinations at least 6 months later after treatment. The demographic and treatment characteristics of eyes with or without hyperfluorescence in FA were analyzed. The different types of hyperfluorescence were divided into three groups, including vascular leakage, fibrous membrane, and vascular abnormality.ResultsTwo hundred and forty-two eyes of 123 patients with treatment-required ROP were included. Hyperfluorescence was defined in 51/242 eyes, and 2.08 ± 1.11 injections were performed for them, while the eyes without hyperfluorescence received 1.65 ± 0.80 injections (P = 0.013). Vascular leakage was defined in 26/51 hyperfluorescence eyes. The postmenstrual age (PMA) of first injection for the hyperfluorescence group was 38.56 ± 3.24 weeks, which is earlier than that of infants without hyperfluorescence (P = 0.011). More additional treatments were performed in eyes with hyperfluorescence (23.53 vs. 3.66%, P = 0.000). Among them, the eyes with vascular leakage required more additional treatment than eyes without vascular leakage (42.31 vs. 4.00%, P = 0.004). For the 26 eyes with vascular leakage, 11 eyes of 8 patients received further treatments during further follow-up. No significant difference of refractive errors can be defined between different groups.ConclusionEyes with persistent hyperfluorescencein FA after treatment required more anti-VEGF and additional treatments, including laser and PPV. Not all hyperfluorescences were vascular leakage and required additional treatment.

Ultra-Widefield Fluorescein Angiographic Patterns, Retinal Microvascular Anomalies and Retinal Ischemic Index in Branch Retinal Vein Occlusions with Established Retinal Neovascularization.

PurposeTo share the experience of using ultra-widefield fluorescein angiography (UWF-FA) in recognizing the potential signs for retinal neovascularizations (NVE) development in branch retinal vein occlusions (BRVO).MethodsReporting angiographic findings in 60 BRVO eyes presenting with NVE and vitreous hemorrhage using UWF-FA investigation. Angiographic retinal ischemic index (ARI) was also calculated from UWF-FA as the ratio of digitally mapped ischemic retina area against area of optic disc, termed unit of disc diameter (DD).ResultsWe observed emerging angiographic features common to these patients: pattern of a localized non-perfused retina at early phase of UWF-FA remaining non-perfused at the late phase (black retinal ischemia, black-RI) (100%); presence of retinal microvascular anomalies (RMAs) at the “water-shed-border” of black-RI (100%); site of NVEs observed at either the same “water-shed-border” (42%) or from the main vessel branch within the black-RI (30%), or from both sites (28%); multiple NVEs were observed in all eyes except two with single active NVE. Median ARI size was 114 DD (SD 80 DD), range 5–354 DD.ConclusionWe report a recurring angiographic pattern common to eyes with active BRVO-NVEs from UWF-FA, and NVEs in this clinical group can develop from varied ARI sizes. Further studies would be needed to establish the role of UWF-FA in predicting angiographic risk factors for BRVO-NVE.

Aqueous Angiographic Outflow Improvement after Trabecular Microbypass in Glaucoma Patients

To study changes in aqueous humor outflow (AHO) patterns after trabecular micro-bypass (TMB) in glaucoma patients using intraoperative sequential aqueous angiography. Prospective comparative case series. Fifteen subjects (14 with glaucoma and 1 normal). Sequential aqueous angiography (Spectralis HRA+OCT; Heidelberg Engineering) was performed on fourteen glaucoma patients undergoing routine TMB (iStent Inject; Glaukos Corporation) and cataract surgery and one normal patient undergoing cataract surgery alone. Indocyanine green (ICG) aqueous angiography established initial baseline nasal angiographic AHO patterns. Two TMB stents were placed in regions of baseline low or high angiographic AHO in each eye (n = 2 eyes with enough space to place two stents in both low angiographic regions; n = 8 eyes with two stents both placed in high angiographic regions; n = 4 eyes with enough space to place one stent in a low angiographic region and the other stent in a high angiographic region). Subsequent fluorescein aqueous angiography was utilized to query alterations to angiographic AHO patterns. Angiographic signal and patterns before and after TMB. At baseline, all eyes showed segmental angiographic AHO patterns. Focused on the nasal hemisphere of each eye, for each stent TMB in initially low ICG angiographic signal regions showed transient or persistently improved fluorescein angiographic signal (11.2-fold; p = 0.014). TMB in initially high ICG signal regions led to faster development of fluorescein angiographic patterns (3.1-fold; p = 0.02). TMB resulted in different patterns of aqueous angiographic AHO improvement whose further understanding may advance basic knowledge of AHO and possibly enhance intraocular pressure reduction after glaucoma surgery in the future.

Choroidal Variations in Diabetic Macular Edema: Fluorescein Angiography and Optical Coherence Tomography

ABSTRACTPurposes: To (i) evaluate variations in choroidal thickness (CT) and choroidal volume (CV) in diabetic macular edema (DME), as demonstrated by fluorescein angiography (FA) and enhanced depth-imaging (EDI) optical coherence tomography (OCT) (EDI-OCT) and (ii) correlate these variations with visual acuity.Methods: This study was a retrospective observational case series of patients with diabetic retinopathy (DR) and DME. The study groups comprised 77 DR patients (n = 87), all of whom underwent color fundus photography, FA, and OCT on the same day. The control group comprised 25 age-matched healthy individuals (n = 50 eyes). CT was measured by manual segmentation (EDI-OCT built-in automated retinal segmentation software). Variations in CT in DME patterns were analyzed.Results: We studied a total of 87 eyes from patients with DR, including 50 eyes from 25 patients with DME (DME group) and 37 eyes from 22 patients without DME (non-DME group). For DME-group patients, mean subfoveal choroidal thickness (SFCT) and total CV (TCV) were 258.8 ± 81.7 µm and 6.6 ± 1.8 mm3, respectively. For non-DME group patients, mean SFCT and TCV values were 247.6 ± 73.3 µm and 6.6 ± 1.6 mm3, respectively. SFCT and TCV values for both groups were significantly lower than for healthy controls (294.3 ± 87.6 µm and 7.7 ± 1.8 mm,3 respectively) (p = 0.040 and 0.019, respectively). CTs varied according to morphological FA and OCT patterns of DME, but did not differ significantly (p > 0.05).Conclusions: CT and CV in DR patients were decreased compared with healthy controls. CTs did not differ significantly between DME patterns demonstrated by OCT and FA.

The Early Treatment Diabetic Retinopathy Study historical review and relevance to today's management of diabetic macular edema.

To provide an historical review of the Early Treatment Diabetic Retinopathy Study (ETDRS) in the management of diabetic macular edema (DME), and to discuss its relevance to the management of DME. The ETDRS reported that argon laser treatment is beneficial in the management of 'clinically significant' DME. The study provided guidelines for the treatment with focal and/or grid laser based on fluorescein angiographic patterns. In today's world, with the advent of optical coherence tomography, 'clinically significant' DME is now classified into center-involved DME (CI DME) and noncenter-involved DME (non-CI DME). Modified ETDRS focal/grid laser photocoagulation has been utilized in more recent clinical trials [diabetic retinopathy clinical research (DRCR) Protocols I and T] in combination with intravitreal injections. The ETDRS provided outcomes data for DME, both untreated and following laser therapy. In the management of patients with DME today, the modified ETDRS focal/grid laser photocoagulation treatments remain relevant in combination with anti-vascular endothelial growth factor (anti-VEGF) therapy as ophthalmologists and their patients choose how best to treat DME. Ongoing studies in eyes with DME, nonproliferative diabetic retinopathy, and good visual acuity will help further define the place of modified ETDRS focal/grid laser in the treatment of DME.

Risk factors of recurrence of macular oedema associated with branch retinal vein occlusion after intravitreal bevacizumab injection

Background/aimsTo identify risk factors of recurrence of macular oedema in branch retinal vein occlusion (BRVO) after intravitreal bevacizumab (IVB) injection.MethodsThe records of 63 patients who underwent IVB injection for macular...

Correlation between clinical, fluorescein angiography and optical coherence tomography findings in clinically significant macular edema

Background: Macular edema is an important cause of visual morbidity in diabetic retinopathy. It can be assessed by both fluorescein angiography (FA) and optical coherence tomography (OCT). Aims: To study, if any, correlation exists between FA and OCT patterns in Clinically significant macular edema (CSME). Furthermore, to correlate macular thickness as determined by OCT to best-corrected visual acuity (BCVA). Materials and Methods: This was a prospective study which compared patterns in FA and OCT in patients with CSME. All the patients who were diagnosed as CSME underwent a complete ophthalmic examination and were subjected to FA and OCT. Those with a hazy media were excluded from the study. The results were analyzed by Fisher's exact test. Results: A total of 32 eyes were studied. FA revealed that most of the patients had diffuse leak (59%), followed by focal leak (31%) and combined leak (10%). On OCT, isolated sponge-like retinal swelling was seen among 66% eyes, spongy retinal swelling with cystoid macular edema/serous foveal detachment in 28% eyes, and 6% had a combined pattern. There was a statistical correlation between FA and OCT findings in our study (P = 0.038). The mean central foveal thickness in our study was 321.75 ΁ 98.30 μm, and there was a statistically significant correlation between central foveal thickness and BCVA (P = 0.043). Conclusion: There is a significant correlation between OCT and FA findings for CSME. Furthermore, the foveal thickness correlates to BCVA.

Correlation of optical coherence tomography and fluorescein angiography imaging in neovascular age-related macular degeneration

Objectives The aim of this work was to study the role of fundus fluorescein angiography and spectral domain optical coherence tomography (SDOCT) in the diagnosis of wet age-related macular degeneration (AMD). Background AMD is the leading cause of severe visual impairment in elderly people. Various imaging methods are available for the diagnosis and the classification of AMD. Fluorescein angiography (FA) is the gold standard for the differential diagnosis of neovascular AMD and determination of lesion characteristics. SDOCT is used for the diagnosis and the follow-up of patients with neovascular AMD undergoing antivascular endothelial growth factor therapy, by providing high-resolution cross-sectional images of retinal pathology. Participants and methods This study included 30 patients divided into three groups: group Me, patients with dry AMD; group II, patients with wet AMD divided into classic choroidal neovascularization (CNV) and occult CNV; group III, patients with geographic atrophy. All participants underwent a full ophthalmologic evaluation, including dilated fundus examination by binocular indirect ophthalmoscope. Slit-lamp biomicroscopy was performed using the Goldman three mirror lens and Volk 78 lens; also, the best-corrected visual acuity was measured with the Landolt chart and converted to the logarithm of the minimum angle of resolution (logMAR) units, and fundus fluorescein angiography and then optical coherence tomography (OCT) were performed. Results Using SDOCT imaging to delineate the lesion morphology, early AMD was detected by the presence of a normal foveal contour and minimal alteration in the macular area, classic CNV by the presence of a well-defined lesion with steep margins and a crater like configuration, and occult CNV by the presence of an ill-defined, flat lesion with a convex surface. FA-OCT overlay images provided a significant correlation between FA patterns and OCT features such as retinal pigment epithelium (RPE) complex changes. The sensitivity of cases with dry AMD in FA to cases with undulation in OCT was 100%, the specificity was 92%, the accuracy was 93%, the positive predictive value (PPV) was 75%, and the negative predictive value (NPV) was 100%. The sensitivity of cases with wet AMD in FA to cases with thickening in OCT was 96%, the specificity was 20%, the accuracy was 83%, the PPV was 86%, and the NPV was 50%. The sensitivity of cases with geographic atrophy of AMD in FA to cases with thinning in OCT was 100%, the specificity was 97%, the accuracy was 97%, the PPV was 50%, and the NPV was 100%. Conclusion SDOCT is highly sensitive for identifying AMD, CNV, and CNV activity, but cannot fully replace FA in the diagnosis of AMD.

Acute macular neuroretinopathy: an atypical case.

The purpose of this report is to describe extensive acute macular neuroretinopathy lesions with atypical features. Retrospective case report. A patient developed acute macular neuroretinopathy in the setting of multiple previously described associations including a flu-like illness, sympathomimetic exposure, overdose of norepinephrine reuptake inhibitors, anemia, thrombocytopenia, and hypotensive shock. The fundus lesions superficially resembled retinal hemorrhages in color and fluorescein angiography pattern. The lesions could be detected on autofluorescence and infrared imaging. Optical coherence tomography revealed outer plexiform layer opacification and photoreceptor abnormalities. This case suggests a compounding effect of factors associated with acute macular neuroretinopathy, possible exacerbating insults and outer plexiform layer abnormalities that may correlate with the temporal course of this condition.

NEW INSIGHTS INTO THE PATHOANATOMY OF DIABETIC MACULAR EDEMA

To describe the pathoanatomy of diabetic macular edema in optical coherence tomography and its correlation with fluorescein angiography patterns. Sixty eyes of 56 patients were analyzed. Diabetic macular edema was classified into typical focal leakage (from microaneurysm), typical diffuse leakage (the capillary plexus), or combined/questionable leakage using fluorescein angiography and retinal thickness profiles. The leakage and pooling patterns in fluorescein angiography were matched to the corresponding optical coherence tomography images and analyzed. Focal leakage shows swelling predominantly in the outer plexiform layer (OPL). Deeply located microaneurysms directly leak into the loose fiber portion of OPL (Henle layer) through the "fluid conductivity barrier" (synaptic portion of OPL). Diffuse leakage caused swelling predominantly in the inner nuclear layer and secondarily in the OPL. The deep capillary plexus is located between the two "fluid barriers" (inner plexiform layer and OPL); thus, diffuse leakage is primarily related with swelling in the inner nuclear layer. In the combined/questionable leakage, partial sections consisting of inner nuclear layer swelling and much larger areas of OPL/outer nuclear layer swelling are noticed. Based on the concept of the fluid conductivity barrier, we revealed a correlation between the intraretinal location of the leakage source and where the fluid accumulated within the retinal layers.

Spectral Domain Optical Coherence Tomography of Vogt-Koyanagi-Harada Disease: Novel Findings and New Insights into the Pathogenesis

To provide novel spectral domain optical coherence tomography (SD OCT) findings of Vogt-Koyanagi-Harada (VKH) disease as well as new insights into the pathogenesis of this disease. Detailed SD OCT and fluorescein angiography (FA) findings of 18 consecutive VKH patients (11 women and 7 men) from December 2007 to April 2009 who were in acute uveitic stage at presentation were reviewed. All the patients had been followed up for at least 6 months with reevaluation(s) of SD OCT performed in 10 patients. Intraretinal cysts were found to be located in various layers of the outer retina. In addition to the photoreceptor layer, they could also be found between the outer plexiform layer and the outer nuclear layer, or spanning the external limiting membrane. On FA, intraretinal cysts could be hypofluorescent, normofluorescent, or hyperfluorescent. Some intraretinal cysts had a characteristic FA pattern, in which a small round hypofluorescent area was surrounded by a ring of hyperfluorescence (donut-shaped dye pooling). Subretinal fibrinoid deposit appeared in acute uveitic stage in two severe VKH patients and seemed to develop from subretinal exudates and evolved into typical subretinal fibrosis. Gradual transfiguration/migration and progressive proliferation/pigmentation of the subretinal fibrinoid deposit/subretinal fibrosis was observed in one patient. Intraretinal cysts could form in various layers of the outer retina and may result from extension of choroidal inflammation. Subretinal fibrosis may develop from subretinal exudates in VKH patients and may cause substantial visual impairment.

Fluorescein angiography patterns associated with the effect of intravitreal bevacizumab injection for diabetic macular edema

Abstract Purpose To analyze the fluorescein angiography (FAG) findings associated with the effect of intravitreal bevacizumab injection (IVB) for treatment of diabetic macular edema (DME). Methods Seventy eyes of 65 patients with DME were included in this prospective, non‐randomized pilot study. The changes in best‐corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were evaluated considering the FAG pattern at baseline and 3 month after IVB. Results On baseline FAG, 20 eyes (28.6%) showed honeycomb type hyperfluorescence; 9 eyes (12.9%), petaloid type; and 41 eyes (58.6%), diffuse type. Three months after IVB, the mean decrease in CMT was 250.5 (198.78) μm in the case of the honeycomb and petaloid type, which was significantly larger than that in the case of the diffuse type 102.5 (147.72) μm (p = 0.03). The improvement in BCVA was 0.27 (0.30) logMAR in the case of the honeycomb and petaloid type and 0.11 (0.27) logMAR in the case of the diffuse type; this difference was statistically significant (p &lt; 0.02). There was no statistical relationship between the leakage starting time and CMT or BCVA. Conclusion The effect of IVB for treatment of DME was better in eyes showing honeycomb and petaloid type hyperfluorescence on baseline FAG than those exhibiting diffuse type hyperfluorescence.

CORRELATION BETWEEN MORPHOLOGIC FEATURES ON SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY AND ANGIOGRAPHIC LEAKAGE PATTERNS IN MACULAR EDEMA

The purpose of this study was to determine the morphologic patterns of angiographic macular edema using simultaneous colocalization of fluorescein angiography and spectral-domain optical coherence tomography (SD-OCT) images in diabetes, epiretinal membrane, uveitic and pseudophakic cystoid macular edema, and vein occlusion. Eighty-seven consecutive patients (107 eyes) with macular edema from 5 different etiologies were imaged by simultaneous scanning laser ophthalmoscopy/OCT to study the morphologic patterns of edema on SD-OCT and then correlated/colocalized with the fluorescein angiographic patterns of leakage. Statistical analysis was done to analyze the differences in the morphologic OCT pattern by different diseases. Spectral-domain OCT characteristics of macular edema showed a significant difference across different diseases (P = 0.037). Cystic fluid pockets were found to be more commonly seen in patients with diabetic macular edema and retinal vein occlusions, whereas those cases with macular edema secondary to epiretinal membrane showed noncystic changes on OCT. Seventy of the 107 eyes had diffuse angiographic leakage, and the remaining 37 eyes had cystoid leakage on angiography. Of the 70 eyes with diffuse leakage, 24.28% showed microcysts on SD-OCT in the area of edema, and 70% eyes had diffuse thickening or distorted architecture without cyst. All 37 eyes with cystoid leakage showed cysts in the area of edema by SD-OCT. A total of 3.73% of eyes with fluorescein angiographic leakage had no abnormalities on SD-OCT. Eyes with diabetic macular edema and retinal vein occlusions have a significantly higher incidence of cyst formation on SD-OCT. There was no correlation between visual acuity and cyst formation. Diffuse noncystoid angiographic macular edema may show microcysts on SD-OCT, but diffuse edema is more commonly associated with thickening or distortion of the retinal layers without cyst formation. Cystoid leakage on fluorescein angiography is always associated with cystic changes on SD-OCT.

Correlation of High-Definition Optical Coherence Tomography and Fluorescein Angiography Imaging in Neovascular Macular Degeneration

To correlate the morphologic characteristics of choroidal neovascular lesions (CNV) in age-related macular degeneration (AMD) using raster scanning high-definition optical coherence tomography (HD-OCT) and conventional fluorescein angiography (FA). In this comparative clinical study, 37 consecutive patients with classic, minimally classic, or occult CNV; 13 patients with early AMD; and 10 age-matched healthy individuals were included. HD-OCT imaging (Topcon, Tokyo, Japan) and FA (scanning retinal ophthalmoscope; HRA2; Heidelberg Engineering, Dossenheim, Germany) were performed after a complete standardized ophthalmic examination. Only one eye of each patient was included in the study. A point-to-point correlation between HD-OCT and FA images was performed. Early and late FA images at defined locations were correlated with OCT measurements, including 3D maps, 2D single scans, a thickness linear graph, and the 3D retinal pigment epithelium (RPE) segmentation. With HD-OCT imaging used to delineate the lesion morphology, early AMD was detected as having a normal foveal contour and minimal alteration in the macular area; classic CNV as a well-defined lesion with steep margins and a craterlike configuration, occult CNV as an ill-defined, flat lesion with a convex surface; and minimally classic CNV as having classic and occult components. FA-OCT overlay images provided a significant correlation between FA patterns and OCT features such as retinal thickness (RT). 3D-OCT provided realistic anatomic maps of the retina, RPE, and RT in patients with AMD. Discrimination between the predominant CNV lesion types was achieved, and their precise shape was identified, together with information about the lesion's localization and leakage activity.

Correlation between Spectral Domain Optical Coherence Tomography Findings and Fluorescein Angiography Patterns in Diabetic Macular Edema

To study the relationship between spectral domain optical coherence tomography (SD-OCT) findings and fluorescein angiography (FA) patterns in patients with diabetic macular edema (DME). Retrospective, observational, cross-sectional study. We included 59 eyes from 59 patients with DME that had SD-OCT/scanning laser ophthalmoscope (SLO) and FA performed on the same day. Eyes with macular edema owing to other ocular diseases were excluded. The relationship between SD-OCT and FA findings was evaluated by superimposing and aligning the SLO images onto the FA photos. The SLO image of the OPKO/OTI Spectral OCT/SLO (OPKO-OTI, Miami, FL) corresponds with the exact origin and orientation of the SD-OCT scan, which was then correlated with the FA image. Foveal and extrafoveal regions were studied separately. Leakage on FA and pathologic changes on OCT were graded by using standard photographs. Pathologic changes studied in the OCT images included edema and cystic spaces in the inner and outer retina, loss of retinal layers, and foveal cysts. Correlation between SD-OCT changes and corresponding FA patterns. The outer retina was the predominant location of fluid in DME. The severity of the outer retinal edema on OCT was positively correlated with the severity of leakage on FA (r = 0.735; P<0.001). Cystic changes in the inner and outer retina were also correlated with the severity of fluorescein leakage (r = 0.507 and P<0.001; r = 0.561 and P<0.001, respectively). Loss of inner retinal layers on OCT was highly correlated with capillary nonperfusion on FA (r = 0.953; P<0.001). Large foveal cysts on SD-OCT corresponded to cystoid leakage patterns on FA. Pathologic changes on SD-OCT correlated well with FA findings. Loss of inner retinal layers was specifically correlated with capillary nonperfusion and severe ischemia. Judgment of whether management of DME based on fine retinal structural changes influences clinical outcomes must be reserved pending further investigation with prospective trials. Proprietary or commercial disclosure may be found after the references.

Correlation between intraretinal changes in diabetic macular oedema seen in fluorescein angiography and optical coherence tomography

To study the relationship between intraretinal optical coherence tomography (OCT) and fluorescein angiography (FA) findings in eyes with diabetic macular oedema (DMO). We carried out a retrospective observational case series. Thirty eyes with previously untreated DMO underwent FA and OCT. The same ETDRS template was overlaid on the FA images in order to compare OCT and FA. Transfoveal linear high-resolution OCT scans (at the 0- and 90-degree meridians) and FA pictures were compared according to the ETDRS rings. Six distinct patterns of intraretinal changes in OCT correlated with changes in FA: (a) focal angiographic leakage did not correspond to any obvious intraretinal abnormality in OCT in four eyes; (b) localized thickening of the outer nuclear layer in OCT corresponded to focal leaking microaneurysm (focal oedema) in FA in 11 eyes; (c) diffuse thickening of the outer nuclear layer in OCT corresponded to diffuse angiographic leakage in 21 eyes; (d) cystoid expansion of the outer nuclear layer was found in seven eyes with a petaloid angiographic pattern of leakage; (e) cystoid expansion of the inner nuclear layer was found in relation to honeycomb angiographic oedema in five eyes, and (f) serous detachment of the fovea in OCT did not correspond to any distinct finding in FA in four eyes. Intraretinal abnormalities found in OCT correlate systemically with changes in FA. Very early DMO morphological changes may be seen better with FA than with OCT. Serous detachment of the fovea is seen in OCT, but not in FA. The combination of OCT and FA is useful in facilitating understanding of the pathophysiological changes that occur in DMO.

Intermediate and combined forms of retinal telangiectasies

Abstract Purpose: Idiopathic retinal telangiectasis are usually classified as Leber ‐ Coats disease or juxtafoveal telangiectasies. Intermediate and combined forms of these vascular disorders are rare and poorly described and understood. Methods: Clinical presentation of four cases of congenital telangiectasies associated to pigment epithelium disorders, two cases associated with optic disc anomalies, nine cases of multifocal progressive retinal telangiectasies and six cases of junctional congenital retinal telangiectasies. Results: Clinical presentations of four types of poorly described and understood congenital retinal telangiectasies considering fluorescein angiography pattern and therapeutic approach. Conclusions: Intermediate and combined forms of congenital retinal telangiectasies are highly interesting in order to attend a more accurate classification of these disorders based on presumed etiopathogenic mechanisms.

Angiografía dinámica con verde indocianina en el diagnóstico de vasos nutricios de complejos neovasculares subfoveales coroideos en la degeneración macular asociada a la edad

This study aimed to assess the detection and characteristics of feeder vessels (FV) of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). A retrospective study of 59 consecutive eyes presenting subfoveal CNV secondary to ARMD was performed. Feeder vessels were detected by means of indocyanine green video angiography using a confocal scanning laser ophthalmoscope. The following factors were analyzed: patient age, visual acuity using Snellen lines and/or ETDRS, fluorescein angiographic (FA) patterns, size of CNV, and time of evolution. The following characteristics of FV also were evaluated: FV pattern (umbrella or racquet-like pattern), number, width and the location with respect to the fovea. FV were detected in 36 subfoveal CNV (61%). No significant differences were noted between the presence of FV in terms of visual acuity (U Mann-Whitney, p=0.816), FA patterns (Fisher's exact probability test p=0.265), size of the CNV (U Mann-Whitney, p=0.267) and time of evolution (U Mann-Whitney, p=0.099). The most common pattern FV was a the racquet-like pattern, inserted in the subfoveal CNV from an extrafoveal origin on the nasal side after a variable course of approximately 1.27 mm (range 0.1-2.9 mm), with a diameter of 83.3 microm (range 20-150 microm). FV were detected in 36 subfoveal CNV (61%) in ARMD. Only 16 subfoveal CNV (25.4%) were considered eligible for FV treatment.