Patients Underwent Fluorescein Angiography Research Articles

Ocular manifestations of severe familial hypercholesterolemia

BackgroundTo study ocular manifestations of patients with severe familial hypercholesterolemia (FH). MethodsIn this population-based case-control study, patients suffering from severe familial hypercholesterolemia from the Lebanese Familial Hypercholesterolemia Registry, along with age and gender-matched healthy controls were recruited. All participants underwent a comprehensive eye examination, and patients underwent fluorescein angiography as well. Logistic regression models were used to identify any association between patients with severe familial hypercholesterolemia and abnormal eye findings, while adjusting for hypertension and pack-year smoking. The main outcome measure of this study was the development of ocular vascular abnormalities. Results28 patients and 28 controls were recruited. Patients with severe familial hypercholesterolemia had significantly greater odds of developing corneal arcus and xanthelasmas than the control group (p < 0.001). Retinal vascular abnormalities (plaques) were exclusively and more significantly present in patients with familial hypercholesterolemia (18 %). Similarly, retinal arteriosclerosis was exclusively and significantly more prevalent in the familial hypercholesterolemia group (p < 0.001, adjusted odds ratio 6.8). Stratification by LDL levels and genotypes did not show any significant change in the prevalence of any ocular finding. ConclusionIn addition to the well-established increase in incidence of corneal arcus and xanthelasmas, severe familial hypercholesterolemia patients have more prevalent retinal vascular abnormalities that include vascular plaques and arteriosclerosis.

Interocular Symmetry of Choroidal Parameters in Patients with Diabetic Retinopathy with and without Diabetic Macular Edema.

This study focuses on the interocular comparison of choroidal parameters in diabetic patients with diabetic retinopathy (DR) with and without diabetic macular edema (DME), as well as in patients with unilateral DME (present in only one eye). The aim of this study was to determine the symmetry in order to obtain better insights into the pathophysiology of diabetic choroidopathy. This retrospective single-center cross-sectional study included 170 eyes from 85 patients (61 with DR and 24 controls), divided into subgroups depending on the presence of DME. The patients underwent fluorescein angiography and spectral domain optical coherence tomography examination, and the analysis included various choroidal parameters: choroidal thickness, volume, and the choroidal vascularity index (CVI). In terms of the choroidal thickness, one eye of a patient with DR, regardless of the presence, absence, or unilaterality of DME, may be treated as representative for that patient. CVI proved symmetrical for controls and patients with DR without DME. However, there was some asymmetry of CVI in patients with bilateral or unilateral DME. There was no straightforward relationship between choroidopathy and DME. Other mechanisms were also involved in the pathogenesis.

Distinct characteristics of central serous chorioretinopathy according to gender

To investigate the differences in clinical and genetic characteristics between males and females with central serous chorioretinopathy (CSC). Consecutive 302 patients (mean age; 56.3 ± 11.7, male/female: 249/53) with CSC were evaluated on the initial presentation. All CSC patients underwent fluorescein angiography and indocyanine green angiography (FA/ICGA), swept-source or spectral-domain optical coherence tomography (OCT), and fundus autofluorescence (FAF) to confirm a diagnosis. All patients were genotyped for rs800292 and rs1329428 variants of CFH using TaqMan technology. On the initial presentation, female patients were significantly older (p = 2.1 × 10–4, female 61.6 ± 12.4 vs male 55.1 ± 11.3) and had thinner subfoveal choroidal thickness (p = 3.8 × 10–5) and higher central retinal thickness (p = 3.0 × 10–3) compared to males. A descending tract was more frequently seen in males than in females (p = 8.0 × 10–4, 18.1% vs 0%). Other clinical characteristics were comparable between the sexes. The risk allele frequency of both variants including CFH rs800292 and CFH rs1329428 was comparable between males and females (CFH rs800292 A allele male 51.2% vs female 47.2%, CFH rs1329428 T allele male 56.2% vs 52.8%). On the initial presentation, age, subfoveal choroidal thickness and central retinal thickness differ between males and females in eyes with CSC. A descending tract may be a strong male finding in CSC.

The Effect of Fluorescein Angiography on Renal Function: A Meta-analysis and Systematic Review

Background. Contrast-induced nephropathy (CIN) is a complication that occurs in patients undergoing an imaging procedure with intravenous injection of contrast media, most notably iodinated dyes. Fluorescein angiography is a diagnostic procedure performed by ophthalmologists to determine abnormalities in retinal blood vessels. It uses sodium fluorescein, an organic dye, to capture and visualize these blood vessels. There have been conflicting data and practices on how to approach the procedure especially in patients with renal insufficiency. Objective. To determine the risk of CIN among patients undergoing fluorescein angiography. Methods. We searched PubMed, HerdIn, Cochrane Library, and Google Scholar, for published articles on the topic. Other sources were searched for unpublished data or ongoing clinical trials. All research articles pertaining to fluorescein angiography and its effect on renal function with serum creatinine monitoring were included. Two independent authors separately screened records, assessed full texts, and extracted data. We used RevMan computer software to analyze data from the included studies. The primary outcome was the risk of CIN among patients undergoing fluorescein angiography based on the differences on serum creatinine levels and estimated glomerular filtration rates pre- and post-angiography, while the secondary outcome included risk factors for CIN. Results. A total of 6 studies were included in the meta-analysis. Four studies had poor quality as assessed using the Newcastle-Ottawa Scale. One study was deemed to have good quality. Data analysis showed that hemoglobin (p = 0.002) and albumin (p &lt; 0.001) levels may be associated with CIN using sodium fluorescein but were not independent risk factors for CIN (multivariable logistic regression, p = 0.648 and p = 0.069, respectively); while sex, diabetes mellitus and chronic kidney disease were not significantly associated. As a primary outcome, only 6.8% of included patients had CIN with serum creatinine levels post-exposure showed significant differences from baseline values (mean difference 0.05; 95% CI 0.02, 0.07; I2 = 49%), but translating it to eGFR yielded non-significant differences (mean difference -0.37; 95% CI -2.33, 1.59; I2 = 0%). Conclusion. Among patients undergoing fluorescein angiography, sodium fluorescein does not pose an increased risk for CIN.

Pigment epithelium detachment treated with sildenafil: a case report

AbstractPurposeCentral serous chorioretinopathy (CSCR) is a pathology of the retina that can be complicated by the appearance of a serous detachment of the pigment epithelium (PED). The exact molecular mechanisms of CSCR have remained uncertain as well as there is no effective medical therapy. We found it interesting to describe a case of CSCR with PED treated with Sildenafil.Case Report53‐year‐old male suffering from chronic CSCR with PED probably resulting from psychological stress and type A personality presented himself for an eye examination stating that he noticed an improvement in visual acuity and metamorphopsia after a daily intake of 15 mg of sildenafil tablets. The patient underwent fluorescein angiography (FA), indocyanine angiography (ICG), Optical coherence tomography angiography (OCTA) and Optical coherence tomography (OCT). The tests showed a resolution of the serous detachment of the neuroepithelium and pigment epithelium with residual dystrophy of the retinal pigment epithelium.ConclusionsSeveral oral medications have been proposed for the treatment of CSCR based on the putative inhibition of different pathogenic pathways. Recently mineralocorticoid receptors antagonists were proposed as a treatment for CSCR patients with persistent subretinal fluid and the results seem encouraging. We believe that in our case the resolution of the clinical picture is due to the improvement of the choroidal vascular picture and in particular of the endothelial function of the choroidal vessels. Recent studies have shown that Phosphodiesterase type 5 (PDE‐5) inhibitors (i.e. sildenafil) have been implicated in improving endothelial function and that this would be at the basis of the vasodilation induced by these molecules.

High Reflectivity and Low Reflectivity Properties on OCTA Influence the Detection of Macular Neovascularization in AMD

Background: In this study, we aimed to discriminate high reflectivity and low reflectivity macular neovascularization (MNV) lesions secondary to age-related macular degeneration (AMD)and to assess the influence of blood flow features on the amount of MNV detected by optical coherence tomography angiography (OCTA).Methods: The study was designed as observational, cross-sectional. Type 1 and type 2 MNV lesions were included. All the patients underwent fluorescein angiography (FA), indocyanine green angiography (ICGA) and OCTA. MNV size was calculated on early FA for type 2 MNV and on both early and late phases of ICGA for type 1 lesions. From OCTA, we calculated both MNV size and MNV reflectivity. We assessed the agreement between FA/ICGA and OCTA MNV sizes. Moreover, we studied the relationship between MNV reflectivity properties and MNV OCTA detection.Results: Fifty eyes (50 patients) were included. MNV was identified as follows: 35 /70%) type 1 and 15 (30%) type 2. We found a good agreement between early ICGA size and OCTA size for type 1 MNV (2.10 ± 1.91 mm2 vs 2.09 ± 1.87 mm2; p &amp;gt; 0.05), whereas MNV lesions turned out to be remarkably bigger on late ICGA phase (3.41 ± 2.87 mm2; p &amp;lt; 0.01). Interestingly, OCTA well-matched with FA in terms of MNV size for type 2 lesions (2.36 ± 2.15 mm2 vs 2.37 ± 2.25 mm2). MNV reflectivity was higher in type 2 MNV and it was strongly associated with the OCTA ability to reconstruct the neovascular network.Conclusion: Our study quantitatively showed that MNV filling pattern and MNV blood flow reflectivity features influence the OCTA detection of the MNV in its entirety.

Vortex Vein Anastomosis at the Watershed in Pachychoroid Spectrum Diseases

To evaluate the vascular changes in vortex veins at the posterior pole in pachychoroid spectrum diseases, including central serous chorioretinopathy (CSC), pachychoroid neovasculopathy without polypoidal lesions (PNV), and pachychoroid neovasculopathy with polypoidal lesions (polypoidal choroidal vasculopathy [PCV]). Retrospective case-control study. Ninety-two eyes of 89 patients with CSC, 61 eyes of 59 patients with PNV, 63 eyes of 61 patients with PCV, and 25 healthy control eyes of 25 age- and gender-matched participants for each pachychoroid spectrum disease. Clinical records of patients with pachychoroid spectrum diseases and healthy controls were reviewed. Multimodal images of each group were analyzed. Swept-source OCT was performed to obtain B-mode and en face images in patients with pachychoroid spectrum diseases and healthy controls. All patients underwent fluorescein angiography, indocyanine green angiography, and OCT. Vortex vein anastomosis at the watershed, determined using en face OCT, and central choroidal thickness (CCT), measured using B-mode OCT, were examined in patients and healthy controls. Patient ages also were taken into consideration. Patients with CSC were the youngest, followed by patients with PNV, and then those with PCV (P < 0.01, CSC vs. PNV and PNV vs. PCV), whereas CSC eyes showed the highest CCT values, followed by the PNV and then the PCV eyes (P < 0.01, CSC vs. PNV; P < 0.05, PNV vs. PCV). Central choroidal thickness was significantly greater in pachychoroid spectrum diseases than in healthy controls. No significant CCT differences were found among healthy controls. Anastomosis between superior and inferior vortex veins was observed in more than 90% of eyes with pachychoroid spectrum diseases, making this finding significantly more frequent than in healthy controls (P < 0.01, each pachychoroid spectrum disease vs. control). Polypoidal choroidal vasculopathy showed a significantly higher rate of anastomosis than CSC (P < 0.05). Anastomosis between superior and inferior vortex veins was found to be a common feature in pachychoroid spectrum diseases. Longstanding vortex vein congestion may lead to the development of pachychoroid spectrum diseases. Choroidal congestion may be compensated for by new drainage routes formed via vortex vein anastomosis.

FLUORESCEIN ANGIOGRAPHY FINDINGS IN UNILATERAL PERSISTENT FETAL VASCULATURE.

This study aims to examine retinal vascular findings for affected eyes and contralateral eyes as well in typical cases of unilateral persistent fetal vasculature. We retrospectively reviewed all patients evaluated at Chang Gung Memorial Hospital, Linkou, for unilateral persistent fetal vasculature between January 2008 and July 2017. All patients underwent fluorescein angiography (FA) examination under general anesthesia. FA was performed using RetCam 3 (Clarity Medical Systems, Inc, Pleasanton, CA). Ten patients (eight male and two female) were identified as having adequate clinical data for the final analysis. The mean age at diagnosis was 13.7 ± 17.2 months (range 1-58). The mean axial length was shorter in the affected eyes as compared to the fellow eyes (17.27 ± 2.8 vs. 20.2 ± 1.7 mm; P = 0.024). In the affected eyes, nine cases (90.0%) showed a concomitant retrolental stalk, avascular peripheral retina, regional capillary dropout, and absence of foveal avascular zone. Hyperfluorescent stalk was seen in seven cases (70.0%). Four eyes (40.0%) showed leaking vessels. Terminal supernumerary branching was seen in two cases (20.0%). Popcorn hyperfluorescence was noted in one case (10.0%). In the fellow eyes, peripheral avascular zone was noted in nine eyes (90.0%), of which six (60.0%) had peripheral zones greater than two-disk diameters. Seven eyes (70.0%) presented with regional capillary dropout and abnormal choroidal filling. Three eyes (30.0%) had abnormal vessel straightening. Aberrant circumferential vessels and leaking spots were seen in two eyes (20.0%). Regional dilation of disk vessels, peripheral vessel dilation, and terminal bulbing were noted in one eye (10.0%). The mean best-corrected visual acuity of the fellow eyes was 20/39 (0.29 in logarithm of the minimum angle of resolution). Retinal vascular abnormalities in the affected eyes and fundoscopically normal fellow eyes of unilateral persistent fetal vasculature patients were found in 100% and 90.0% of patients, respectively. Fellow eyes had some subtle abnormalities that were only revealed through FA. These unilateral persistent fetal vasculature cases were still bilaterally affected.

Evaluating Retinal Angiomatous Proliferation With Optical Coherence Tomography Angiography.

To report the imaging features of different stages of retinal angiomatous proliferation (RAP) on optical coherence tomography angiography (OCTA). Patients diagnosed with RAP were included in this study. All patients underwent fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCTA. The OCTA features were illustrated and compared with FA, ICGA, and OCT. OCTA was performed at baseline and after injection of anti-vascular endothelial growth factor (VEGF). A total of 12 eyes of 12 consecutive patients were included. Patients' ages ranged from 57 to 82 years. In all cases, the hot spot lesions found on FA or ICGA were clearly detected on OCTA in the same area (12/12, 100%). Hot spot lesions showed variable patterns. Four patients had multiple hot spot lesions located on the outer retina layer, deep layer, or superior retinal layer. OCTA showed a clearer location and relationship with feeder vessels compared with FA or ICGA. Eight patients had received anti-VEGF therapy 1.75 ± 1.06 times. Follow-up OCTA images demonstrated smaller and fewer hot spot lesions with lesser blood flow signal. OCTA is a noninvasive, fast imaging modality for detecting microvascular changes, and it provides more detail of the RAP lesion and related vessels than ICGA or FA. OCTA would be a valuable tool for follow-up observation. The OCTA patterns of RAP may be helpful in understanding its pathology. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:136-144.].

Retinal vascular inflammatory and occlusive changes in infectious and non-infectious uveitis.

Retinal vasculitis and occlusive changes are important signs of posterior uveitis and are possible diagnostic markers for uveitis. However, the frequency of arteritis and phlebitis in various uveitis entities, including infectious uveitis (IU) and non-infectious uveitis (NIU), have not been systematically investigated. Retrospective. We investigated the frequency of retinal vascular inflammatory and occlusive changes in patients with IU and NIU. The study included 283 patients with intermediate, posterior, or pan-uveitis who were diagnosed with IU (presumed tuberculous uveitis, acute retinal necrosis, cytomegalovirus retinitis, human T-cell lymphotropic virus type 1-associated uveitis, toxoplasmic retinitis, syphilitic uveitis, rubella virus-associated uveitis, fungal endophthalmitis, and bacterial endophthalmitis) or NIU (sarcoidosis, Behçet's disease, Vogt-Koyanagi-Harada disease, human leukocyte antigen-B27-associated uveitis, systemic lupus erythematosus retinopathy, psoriatic uveitis, rheumatoid arthritis/collagen disease-associated uveitis, multiple sclerosis-associated uveitis, and sympathetic ophthalmia). All patients underwent fluorescein angiography (FA) and color photography examinations of the fundus. Presence of inflammatory and occlusive changes was determined by FA images. Significantly higher positive ratios of phlebitis, vein sheathing, vein occlusion, arteritis, artery sheathing, artery occlusion, and avascular areas were observed in the IU group than in the NIU group (p < 0.05). Notably, the discrepancy between IU and NIU was prominent with regard to retinal arterial changes (arteritis [57.9% vs 11.2%], inflammatory artery sheathing [33.7% vs 0%], and artery occlusion [22.1% vs 3.7%], respectively; p < 0.0001). Findings of vasculitis and occlusion, especially in retinal arteries, in FA strongly suggest an infectious origin of active uveitis.

QUANTITATIVE ANALYSIS OF STRUCTURAL ALTERATIONS IN THE CHOROID OF PATIENTS WITH ACTIVE BEHÇET UVEITIS.

To quantitatively analyze in vivo morphology of subfoveal choroid during an acute attack of Behçet uveitis. In this prospective study, 28 patients with Behçet uveitis of ≤4-year duration, and 28 control subjects underwent enhanced depth imaging optical coherence tomography. A novel custom software was used to calculate choroidal stroma-to-choroidal vessel lumen ratio. Subfoveal choroidal thickness was measured at fovea and 750 μm nasal, temporal, superior, and inferior to fovea. Patients underwent fluorescein angiography and indocyanine green angiography. Receiver operating characteristic curve and area under the curve were computed for central foveal thickness. The eye with a higher Behçet disease ocular attack score 24 was studied. The main outcome measures were choroidal stroma-to-choroidal vessel lumen ratio and choroidal thickness. The mean total Behçet disease ocular attack score 24, fluorescein angiography, and indocyanine green angiography scores were 7.42 ± 4.10, 17.42 ± 6.03, and 0.66 ± 0.73, respectively. Choroidal stroma-to-choroidal vessel lumen ratio was significantly higher in patients (0.413 ± 0.056 vs. 0.351 ± 0.063, P = 0.003). There were no significant differences in subfoveal choroidal thickness between patients and control subjects. Choroidal stroma-to-choroidal vessel lumen ratio correlated with retinal vascular staining and leakage score of fluorescein angiography (r = 0.300, P = 0.036). Central foveal thickness was significantly increased in patients (352.750 ± 107.134 μm vs. 263.500 ± 20.819 μm, P < 0.001). Central foveal thickness showed significant correlations with logarithm of minimum angle of resolution vision, Behçet disease ocular attack score 24, total fluorescein angiography score, retinal vascular staining and/or leakage and capillary leakage scores of fluorescein angiography, and total indocyanine green angiography score. At 275 μm cutoff, diagnostic sensitivity and specificity of central foveal thickness for acute Behçet uveitis were 89% and 72%, respectively (area under the curve = 0.902; 95% CI = 0.826-0.978, P < 0.001). There was choroidal stromal expansion which was not associated with thickening of the choroid. Central foveal thickness may be used as a noninvasive measure to assess inflammatory activity in early Behçet uveitis.

Analysis of changes in serum levels of endothelin-1 in patients with retinal vein occlusion

Aim. To analyze the level of endothelin-1 in blood serum in patients with retinal venous occlusions. Metods. 60 patients with macular edema due to retinal vein occlusion (RVO) were included in the study. 19 patients were diagnosed with central retinal vein occlusion, 9 of them had non-ischemic type and 10 had ischemic type of central retinal vein occlusion. 41 patients had branch retinal vein occlusion, 23 of them had non-ischemic type and 18 had ischemic type of occlusion. Patients underwent fluorescein angiography and optical coherence tomography fundus imaging. Before intravitreal injection of ranibizumab, the level of endothelin-1 in the blood serum was determined. Analysis was performed in patients’ subgroups depending on the localization of occlusion, type of occlusion, disease relapse, presence of optic disc swelling. &#x0D; Results. Differences in the systemic level of endothelin-1, depending on the localization of occlusion, presence of ischemic type and relapse, the disease was not detected (p ≥0.05). With the development of optic disc swelling, a statistically significant increase in the level of endothelin-1 was noted in peripheral blood: 38.73 fmol/ml in patients with optic disc swelling and 27.65 fmol/ml in patients without it (p=0.018). &#x0D; Conclusion. In patients with optic disc swelling a statistically significant increase of endothelin-1 in blood was revealed.

Lower incidence of contrast-induced nephropathy in patients undergoing fluorescent angiography

BackgroundTo evaluate the incidence and risk factors of contrast-induced nephropathy (CIN) in patients undergoing fluorescein angiography (FA).MethodsOne hundred sixty patients who underwent FA as a part of ophthalmic examination and had serum creatinine (SCr) results within 24 h before FA and within 72 h after FA between 2005 and 2013 at a tertiary medical center were included. According to baseline SCr levels, the subjects were divided into low-risk group (<1.5 mg/dL), intermediate-risk group (1.5–2.0 mg/dL), and high-risk group (>2.0 mg/dL) for CIN development. The CIN incidence, and changes in renal function defined by SCr levels and estimated glomerular filtration rate (eGFR) were evaluated. Demographics and comorbidities were analyzed to investigate an association with CIN development.ResultsOf 160 patients, 91 were males (56.9%). The mean age was 52.46 ± 17.81 years. Two (1.3%) patients developed CIN after FA, whose SCr levels returned to normal within 10 days without hemodialysis. Overall, there were no changes before and after FA in SCr level (1.52 ± 1.31 mg/dL vs. 1.51 ± 1.28 mg/dL, respectively; p = 0.93) and eGFR (67.02 ± 36.62 mL/min/1.73 m2 vs. 66.41 ± 36.54 mL/min/1.73 m2, respectively; p = 0.54). SCr level and eGFR remained unchanged after FA in low-risk and intermediate-risk groups. In high-risk group, eGFR remined unchanged, but SCr level decreased after FA (from 3.64 ± 1.59 mg/dL to 3.53 ± 1.60 mg/dL; p = 0.04). Basline SCr and cormorbidities did not predict CIN development.ConclusionsAcute renal function deterioration was not evident in patients undergoing FA regardless of baseline renal function and comorbidities.

Demographic features of idiopathic macular telangiectasia in Korean patients.

PurposeTo investigate the clinical and demographic features of idiopathic macular telangiectasia (MacTel) in Korean patients since the introduction of spectral domain optical coherence tomography (SD-OCT).MethodsWe reviewed medical records of patients who were diagnosed with MacTel from 2009 to 2013. All patients underwent fluorescein angiography and SD-OCT and were classified as type 1 or type 2 according to the classification system proposed by Yannuzzi.ResultsOver a period of 5 years, 4 (18.2%) patients were diagnosed with type 1 MacTel and 18 (81.8%) patients were diagnosed with type 2 MacTel. All patients with type1 MacTel were male, and their mean age was 51 ± 8.6 years. Among patients with type 2 MacTel, 3 (16.7%) were male, 15 (83.3%) were female, and the mean age was 60 ± 13.6 years. Whereas all type 1 MacTel patients had either metamorphopsia or mild scotoma, of the 18 patients with type 2 MacTel, only 4 (22.2%) had those symptoms, 10 (55.6%) complained of only mild visual impairment, and the other 4 (22.2%) had no symptoms. Intraretinal cystoid spaces were observed in 26 (72.2%) of 36 eyes with type 2 MacTel by SD-OCT. These cystoid spaces had irregular boundaries and did not correspond to angiographic leakages.ConclusionsType 2 MacTel was most common in the present study. The wider availability of SD-OCT may have contributed to the diagnosis of type 2 MacTel. Type 2 MacTel may be more prevalent than type 1 in Koreans, which corresponds to the results of Western countries.

A prospective study of microscope-integrated intraoperative fluorescein videoangiography during arteriovenous malformation surgery: preliminary results

The authors report on the use of a recently developed microscope-integrated fluorescent module using low-dose intravenous fluorescein for videoangiography during arteriovenous malformation (AVM) surgery. The authors analyzed the application of a low-dose intraoperative fluorescein in 4 consecutive patients undergoing AVM surgery. The ability to distinguish the associated vessels of the AVM from normal vessels and to assess the degree of AVM obliteration based on videoangiography of venous drainage was specifically analyzed. All 4 patients underwent fluorescein angiography without complication. In each case, videoangiography confirmed recognition of feeding arteries and draining veins through the operating oculars under the fluorescent mode. In one case involving a large frontal AVM, videoangiography demonstrated mainly cortical veins on the surface of the AVM and alerted the senior author to first tackle the feeding arteries in the interhemispheric space. While evaluating the flow within the different draining veins after most of the AVM was disconnected, videoangiography also prioritized the order for disconnection of large draining veins to allow mobilization the AVM and exposure of the remaining deep arterial feeders. In the other 3 cases, videoangiography allowed easy recognition of the angioarchitecture of the AVMs, estimated its cortical boundaries, and most importantly, assessed the flow within the draining veins before their disconnection. The authors found fluorescein videoangiography to be a useful adjunct in resection of AVMs. This technology offers the unique ability to visualize fluorescent vessels and nonfluorescent tissues in near-natural colors simultaneously and permits microsurgical manipulation of relevant structures under the fluorescent mode. Larger-scale studies are needed to establish its efficacy and wider applicability.

Demographic features of idiopathic macular telangiectasia in Japanese patients

Idiopathic macular telangiectasia (MacTel) is classified into aneurysmal telangiectasia (type 1), perifoveal telangiectasia (type 2) and occlusive telangiectasia (type 3). Most instances of telangiectasia in Western countries are type 2. This study reports clinical and demographic features of MacTel in Japanese patients. Newly diagnosed patients with MacTel were examined retrospectively. All patients underwent fluorescein angiography and optical coherence tomography. Thirty-four eyes of 27 patients with MacTel were included. Twenty eyes of 20 patients (74.1%) had type 1, ten eyes of five patients (18.5%) had type 2, and four eyes of two patients (7.4%) had type 3. Foveal capillary dilatation and microaneurysms were observed in all except for one eye of early stage type 2 MacTel. Optical coherence tomography revealed cystoid macular edema in type 1, temporal foveal thinning and a loss of boundary between the inner and outer segments of photoreceptors in type 2, and thinning of all retinal layers around the fovea in type 3. The most frequent among our patients was aneurysmal MacTel, whereas perifoveal MacTel was not common. Although the clinical characteristics were similar, the most common type was different from that in Western countries.

Foveal Shape and Structure in a Normal Population

The shape of the human fovea presents important but still poorly characterized variations. In this study, the variability of the shape and structure of normal foveae were examined. In a group of 110 eyes of 57 healthy adults, the shape and structure of the fovea were analyzed by automated segmentation of retinal layer on high-resolution optical coherence tomography scans. In an additional group of 10 normal eyes of 10 patients undergoing fluorescein angiography, the size of the foveal avascular zone (FAZ) was correlated to foveal shape. From the thickest to the thinnest fovea, there was a structural continuum ranging from a shallow pit with continuity of the inner nuclear layer (INL) over the center (seven eyes; 6.7%), to a complete separation of inner layers overlying a flat and thinner central outer nuclear layer (ONL; eight eyes; 7.3%). Central foveal thickness correlated inversely to the degree of inner layer separation and to the surface of the FAZ. Foveal structure strongly correlates with its neurovascular organization. The findings support a developmental model in which the size of the FAZ determines the extent of centrifugal migration of inner retinal layers, which counteracts in some way the centripetal packing of cone photoreceptors.

Renal Function Following Fluorescein Angiography in Diabetic Patients With Chronic Kidney Disease

Intravenous fluorescein angiography has been widely used in evaluating diabetic retinopathy. Diabetic patients in whom fluorescein angiography is crucial are likely to have chronic kidney disease (CKD) because retinopathy and nephropathy usually progress in parallel. Although numerous reports have been published concerning the development of adverse reactions after fluorescein angiography (1–3), to the best of our knowledge, it has never been debated in the literature whether fluorescein (noniodinated contrast media) induces nephropathy as does iodinated radiocontrast. Therefore, we conducted this hospital-based retrospective cohort study to determine whether fluorescein angiography is associated with deterioration of renal function in diabetic patients with CKD. Among consecutive diabetic patients undergoing fluorescein angiography to assess retinopathy at the Department of Ophthalmology, …

Optical Coherence Tomography Fast versus Regular Macular Thickness Mapping in Diabetic Retinopathy

Objective: The purpose of the study was to investigate if absolute values and reproducibility of thickness maps obtained from 2 optical coherence tomography (OCT) scanning protocols, regular high-resolution and fast low-density mode, differ in patients with diabetic macular edema. Methods: A total of 26 consecutive patients undergoing fluorescein angiography and Stratus OCT scanning for the evaluation of diabetic macular edema at the Departments of Ophthalmology in Munich and Vienna were included. Results: Retinal thickness of the central field of the thickness map measured by fast retinal thickness protocol was 287 ± 97 and 290 ± 113 µm by the regular protocol. This difference as well as that for all other fields was not statistically significant. Three times repeated measurements applying both OCT scanning modes in 10 patients yielded very good intrasession correlation coefficients between 0.70 and 0.99, with corresponding intrasession standard deviations ranging between 6 and 16 µm. The fast mode yielded slightly less reproducible values than the regular mode. Visual acuity did not influence the results. Conclusion: In practice both scanning modes can be interchanged and absolute values can be compared directly. Best reproducibility is obtained with higher sampling density even in patients with reduced visual acuity due to diabetic macular edema.

Peripheral retinal neovascularization in talc retinopathy

Background Neovascularization of the peripheral retina can be present in a number of systemic and ocular diseases. Very rarely, peripheral retinal neovascularization can also be manifested in intravenous drug abusers. In addition to ocular complications, intravenous drug abusers are at high risk for contracting various infections and the development of pulmonary and cardiovascular diseases. We present a case of a chronic heroin and cocaine abuser with bilateral peripheral retinal neovascularization, pulmonary complications, and a history of endocarditis. Case report A patient with a 20-year history of heroin and cocaine abuse initially presented for a routine eye examination. Fundus examination revealed pinpoint white deposits centered in both maculas, engorged vascular fronds with a patch of intraretinal hemorrhage in the peripheral retinal of the right eye and neovascularization of the disc as well as exudation with adjacent focal preretinal hemorrhage in the left eye. The patient underwent fluorescein angiography and was screened for diabetes, sarcoidosis, and sickle cell disease. When no systemic disease could be discovered, it was concluded that the peripheral retinal neovascularization developed as a result of vascular occlusion from heroin and cocaine abuse. Discussion It is important to investigate the cause of neovascularization in the peripheral retina. Retinal vascular emboli such as talc are common in drug abusers, but in most cases, the retinal deposits pose only a minimal threat to vision. However, this case shows that careful retinal examination is warranted in drug abusers to rule out neovascularization of the retina. Other causes of peripheral retinal neovascularization should be ruled out as well. These conditions include sickle cell retinopathy, sarcoidosis, diabetic retinopathy, blood dyscrasias, retinal vascular occlusion, Eales’ disease, and other systemic conditions, so that appropriate ocular and systemic treatment can be provided. Peripheral retinal neovascularization is best treated by pan-retinal photocoagulation.