Wide-field Angiography Research Articles

Fractal Dimension Analysis of Widefield Choroidal Vasculature as Predictor of Stage of Macular Degeneration.

PurposeTo evaluate the fractal dimension (Df) of the choroidal vasculature using widefield indocyanine green (ICG) angiography and correlate it with the stage of age-related macular degeneration (AMD).MethodsWidefield ICG angiography performed on 38 eyes was retrospectively analyzed using the FracLac application within the National Institutes of Health ImageJ software to determine regional fractal dimensions in the macular field and widefield. These values were then associated with a diagnosis of no AMD, non-exudative AMD (subdivided into early/intermediate stage vs. advanced stage), or exudative AMD (subdivided into with or without geographic atrophy). The mean values were compared using Wilcoxon's test.ResultsEarly/intermediate non-exudative AMD and exudative AMD without geographic atrophy were found to have statistically significantly lower Df values compared to an absence of AMD when examining the macular field. Exudative AMD with geographic atrophy was found to have a statistically significant lower choroidal fractal dimension compared to no AMD when studied in the widefield.ConclusionsAdvanced stages of macular degeneration were found to have significantly decreased the fractal dimensions of choroidal vasculature on widefield ICG compared to early/intermediate stages, possibly implying a generalized reduction in complexity and/or vessel caliber of the choroid with advancing stage of AMD. This finding agrees with previous understanding of the development of choriocapillaris atrophy in advanced macular degeneration.Translational RelevanceThese findings suggest that using automated fractal analysis techniques can aid in differentiating stages of macular degeneration and, with further study, may be used to predict advancement of macular degeneration.

Optical-coherence tomography angiography and ultrawide-field angiography findings in eyes with refractory macular edema secondary to retinal vein occlusion switched to aflibercept: A subanalysis from a 48-week prospective study.

PURPOSE:To evaluate anatomical changes on ultra-wide-field fluorescein-angiography and optical coherence angiography (OCT-A) among a cohort with treatment-resistant macular edema secondary to retinal vein occlusions (RVO) switched to aflibercept.MATERIALS AND METHODS:Patients with persistent macular edema despite previous bevacizumab and/or ranibizumab were switched to aflibercept in a 48-week prospective trial. Ultra-wide-field fluorescein angiography (UWFFA) and OCT-A were performed at baseline, week-24 and week-48. The ischemic index was calculated from UWFFA and the areas of vascular perfusion. The foveal avascular zone (FAZ) were quantitatively evaluated on OCT-A.RESULTS:Eighteen patients (mean age, 70.3±8.6 years) were recruited. Mean central macular thickness (CMT) was significantly reduced at 48-weeks compared to baseline (-87.6±48.8 μm, P < 0.001 and -191.0±128.3μm, P < 0.001 among BRVO and CRVO eyes, respectively). The mean baseline ischemic index as measured on Optos wide-field angiography was 10.9%±8.3 and decreased to 5.7%±4.2 (P = 0.028), at week 48. The mean FAZ areas of the SCP and DCP reduced by -0.06 ± 0.12 mm 2 and -0.17± 0.45 mm 2 , respectively. FAZ area on OCT-A was stable in eyes with stable or improved vision but increased in size in eyes with baseline macular ischemia and those with lower gains in BCVA at week 48 (R 2 =0.719, P = 0.05 and R 2 =0.516, P = 0.01).CONCLUSION:There was a reduction in macular edema measured on OCT at 48-weeks in eyes switched to aflibercept with chronic macular edema due to retinal vein occlusion. There was also a reduction in retinal ischemia as measured using UWFFA.

High-resolution wide-field OCT angiography with a self-navigation method to correct microsaccades and blinks.

In this study, we demonstrate a novel self-navigated motion correction method that suppresses eye motion and blinking artifacts on wide-field optical coherence tomographic angiography (OCTA) without requiring any hardware modification. Highly efficient GPU-based, real-time OCTA image acquisition and processing software was developed to detect eye motion artifacts. The algorithm includes an instantaneous motion index that evaluates the strength of motion artifact on en face OCTA images. Areas with suprathreshold motion and eye blinking artifacts are automatically rescanned in real-time. Both healthy eyes and eyes with diabetic retinopathy were imaged, and the self-navigated motion correction performance was demonstrated.

Ultra-stable near-infrared Tm3+-doped upconversion nanoparticles for in vivo wide-field two-photon angiography with a low excitation intensity

Two-photon luminescence with near-infrared (NIR) excitation of upconversion nanoparticles (NPs) is of great importance in biological imaging due to deep penetration in high-scattering tissues, low auto-luminescence and good sectioning ability. Unfortunately, common two-photon luminescence is in visible band with an extremely high exciation power density, which limits its application. Here, we synthesized NaYF4:Yb[Formula: see text]Tm@NaYF4 upconversion NPs with strong two-photon NIR emission and a low excitation power density. Furthermore, NaYF4:Yb[Formula: see text]Tm@NaYF4@SiO2@OTMS@F127 NPs with high chemical stability were obtained by a modified multilayer coating method which was applied to upconversion NPs for the first time. In addition, it is shown that the as-prepared hydrophillic upconversion NPs have great biocompatibility and kept stable for 6 hours during in vivo whole-body imaging. The vessels with two-photon luminescence were clear even under an excitation power density as low as 25[Formula: see text]mW[Formula: see text]cm2. Vivid visualizations of capillaries and vessels in a mouse brain were also obtained with low background and high contrast. Because of cheaper instruments and safer power density, the NIR two-photon luminescence of NaYF4:Yb[Formula: see text]Tm@NaYF4 upconversion NPs could promote wider application of two-photon technology. The modified multilayer coating method could be widely used for upconversion NPs to increase the stable time of the in vivo circulation. Our work possesses a great potential for deep imaging and imaging-guided treatment in the future.

Purtscher-like Retinopathy Associated with Systemic Lupus Erythematosus Observed Using Wide-field OCT Angiography

Purtscher-like Retinopathy Associated with Systemic Lupus Erythematosus Observed Using Wide-field OCT Angiography

Invariant features-based automated registration and montage for wide-field OCT angiography.

The field of view of optical coherence tomography angiography (OCTA) images of the retina can be increased by montaging consecutive scans acquired at different retinal regions. Given the dramatic variation in aberrations throughout the entire posterior pole region, it is challenging to achieve seamless merging with apparent capillary continuity across the boundaries between adjacent angiograms. For this purpose, we propose herein a method that performs automated registration of contiguous OCTA images based on invariant features and uses a novel montage algorithm. The invariant features were used to register the overlapping areas between adjacently located scans by estimating the affine transformation matrix needed to accurately stitch them. Then, the flow signal was compensated to homogenize the angiograms with different brightness and the joints were blended to generate a seamless, montaged wide-field angiogram. We evaluated the algorithm on normal and diabetic retinopathy eyes. The proposed method could montage the angiograms seamlessly and provided a wide-field of view of retinal vasculature.

Longitudinal Wide-Field Swept-Source OCT Angiography of Neovascularization in Proliferative Diabetic Retinopathy after Panretinal Photocoagulation

Wide-field swept-source (SS) OCT angiography (OCTA) was compared with ultrawide-field (UWF) fluorescein angiography (FA) for evaluating neovascularization (NV) before and after panretinal photocoagulation (PRP) in eyes with treatment-naive proliferative diabetic retinopathy (PDR). Prospective, observational, consecutive case series. Patients with treatment-naive PDR. Patients were imaged using the SS OCTA 12× 12-mm field of view (PLEX Elite 9000; Carl Zeiss Meditec, Inc, Dublin, CA) at baseline and at 1 week, 1 month, and 3 months after PRP. Select eyes were imaged with 5 SS OCTA 12× 12-mm scans to create posterior pole montages. Ultrawide-field fundus photography and UWF FA were obtained at baseline and 3 months after PRP. Neovascularization visualized using wide-field SS OCTA and UWF FA. From January through May 2018, wide-field SS OCTA was performed on 20 eyes with treatment-naive PDR from 15 patients. The en face SS OCTA 12× 12-mm vitreoretinal interface (VRI) slab images showed NV at baseline in 18 of 20 eyes (90%). Of the remaining 2 eyes, the posterior pole montage captured peripheral NV in one eye, and in the other eye, no evidence of NV was detected with either UWF FA or SS OCTA. After PRP, both SS OCTA and FA demonstrated similar progression or regression of NV, but SS OCTA provided more detailed visualization of the vascular changes. Neovascularization in PDR can be identified at baseline and imaged serially after PRP using wide-field SS OCTA. In patients with a high clinical suspicion for PDR, wide-field SS OCTA likely will betheonlyimaging method needed for diagnosis and longitudinal evaluation of NV.

Fluorescein Angiography, Wide Field Angiography, and Indocyanine Green Angiography in Behcet Uveitis

In Behcet's disease, the anterior and posterior segments of the eye may be affected separately or together. Fundus fluorescein angiography should be performed in addition to ophthalmoscopic examination for early diagnosis and treatment of ocular involvement. Fundus fluorescein angiography (FFA) is the gold standard for the evaluation of the retinal vascular system and pathologies. Fundus fluorescein angiography is more sensitive than fundus examination in the detection of vasculitis, and angiographic involvement is always more common than clinical involvement. Fluorescein angiography may reveal leakage from retinal veins in eyes whose visual impression is not affected and the fundus examination is normal. The absence of vascular leakage with fluorescein angiography indicates that the disease is in a completely inactive period. Because of the development of blindness due to posterior segment involvement, early detection of the disease with fundus angiography and the initiation of the treatment is successful in terms of visual prognosis. It has an important place in terms of early activation of patients with FFA in the early diagnosis of eye involvement and follow-up of the disease and treatment. Wide-field imaging angiography imaging of the retinal periphery revealed the importance of lesions in retinal periphery and peripheral areas invisible by standard angiography. The use of indocyanine green angiography in Behcet uveitis is limited.

Wide-Field Swept-Source OCT and Angiography in X-Linked Retinoschisis

Retinal vascular and structural changes, particularly outside of the central macula, are not well characterized in X-linked retinoschisis (XLRS). We aim to describe wide-field swept-source OCT (SS-OCT) and swept-source OCT angiography (SS-OCTA) findings in XLRS. Retrospective, cross-sectional study at a tertiary referral center. Nine consecutive male patients with molecularly confirmed XLRS. All patients underwent complete ophthalmic examination with multimodal imaging, including SS-OCT with SS-OCTA (PLEX Elite 9000; Carl-Zeiss Meditec Inc., Dublin, CA). Images were then reviewed by 2retinal specialists as independent graders to determine the frequency and distribution of retinal structural and vascular abnormalities. Structural and vascular abnormalities seen on SS-OCT and SS-OCTA in patients with XLRS, with attention to the retinal layers involved, the regional distribution of schitic spaces in the posterior pole, and vascular abnormalities within the superficial and deep capillary plexuses. Eighteen eyes from 9 male patients (mean age, 20 years; range 9-40) with molecularly confirmed XLRS were included. Median best-corrected visual acuity measured 20/63 (range, 20/25-10/300). A total of 17 of 18 eyes (94.4%) were noted to have schitic spaces on SS-OCT, and these were observed to be predominantly within the inner nuclear layer in all 17 eyes. A regional variation in the distribution of cysts was noted, with schitic spaces within the ganglion cell layer (13/17 eyes; 76.5%) observed to be perifoveal and those within the outer nuclear layer (8/17 eyes, 47.1%) observed to be mostly extramacular. All eyes had vascular abnormalities on SS-OCTA, including an irregular foveal avascular zone and flow loss within the deep capillary plexus corresponding to the distribution of the schisis. Wide-field SS-OCT and SS-OCTA provide detailed visualization of structural and vascular changes in XLRS and may be helpful for monitoring disease progression or treatment response in clinical trials for the disease.

Extension of peripheral nonperfusion in eyes with retinal vein occlusion during intravitreal dexamethasone treatment.

To evaluate the change in peripheral perfusion status in patients with retinal vein occlusion (RVO) during dexamethasone treatment. Thirty-five eyes of patients with macular oedema due to either branch or central retinal vein occlusion were included. At baseline, patients were treated with an intravitreal dexamethasone implant (Ozurdex® ) and followed until month 6. Wide-field angiographies were classified as ischaemic and nonischaemic. Peripheral nonperfusion (PNP) was determined manually by calculating the percentage of nonperfusion area in relation to the total visible retina (ischaemic index). Thirteen eyes showed evidence of >10 disc area of PNP at baseline and were graded as ischaemic RVO. In nonischaemic eyes, the mean area of PNP was 0.3% at baseline, 0.6% after 1month, 0.6% after 3months and 0.6% after 6months, respectively (p>0.05). In ischaemic RVO, the ischaemic index was calculated to be 18% at baseline. One month after treatment, mean area of PNP was 16% and after 3months was 19% (p=0.8; p=0.6). After retreatment, total PNP area was 18% (month 6; p=0.9). During treatment, best-corrected visual acuity (BCVA) increased and central retinal thickness (CRT) decreased from baseline to final follow-up with no differences between nonischaemic/ischaemic RVO. A significant negative correlation between the total area of PNP and visual acuity was identified (r=-0.6; p=0.04). Using 200° wide-field fluorescein angiography, the ischaemic index was shown to remain stable during dexamethasone treatment. This finding was consistent in ischaemic as well as in nonischaemic conditions.

Wide-field absolute transverse blood flow velocity mapping in vessel centerline.

We propose a wide-field absolute transverse blood flow velocity measurement method in vessel centerline based on absorption intensity fluctuation modulation effect. The difference between the light absorption capacities of red blood cells and background tissue under low-coherence illumination is utilized to realize the instantaneous and average wide-field optical angiography images. The absolute fuzzy connection algorithm is used for vessel centerline extraction from the average wide-field optical angiography. The absolute transverse velocity in the vessel centerline is then measured by a cross-correlation analysis according to instantaneous modulation depth signal. The proposed method promises to contribute to the treatment of diseases, such as those related to anemia or thrombosis.

THE CUTTING EDGE OF RETINOPATHY OF PREMATURITY CARE: Expanding the Boundaries of Diagnosis and Treatment.

To discuss the latest advances and controversies in the diagnosis and care of infants with retinopathy of prematurity (ROP). Literature review. Retinopathy of prematurity remains a major global issue. Industrialized nations now treat profoundly premature infants with posterior and aggressive disease, and middle-income nations are experiencing ROP epidemics. Remote digital imaging may address the decreasing ratio of ROP providers to premature infants, in addition to improving patient care. Widefield angiography, optical coherence tomography, and the Wnt signaling pathway have provided new insights into ROP pathogenesis. Anti-vascular endothelial growth factor treatment is increasing in popularity, but the dearth of information to guide dosing, unpredictable reactivation, persistent vascular abnormalities, the "crunch" phenomenon, and the presently unknown effects of systemic vascular endothelial growth factor suppression remain issues to continue investigating. Neurodevelopmental delay has been raised as a potential consequence, but the evidence currently is weak. Vitrectomy is the treatment of choice for Stages 4 and 5. Illumination techniques, ab interno incisions, plasmin-assisted vitrectomy, staged surgery in the interest of corneal clearing for advanced Stage 5, and immediate sequential bilateral vitreoretinal surgery, are useful techniques. We are making progress in ROP management. Our goal as clinicians is to continue expanding the boundaries of our abilities to keep this blinding disease in check globally.

Challenges and advantages in wide-field optical coherence tomography angiography imaging of the human retinal and choroidal vasculature at 1.7-MHz A-scan rate.

We present noninvasive, three-dimensional, depth-resolved imaging of human retinal and choroidal blood circulation with a swept-source optical coherence tomography (OCT) system at 1065-nm center wavelength. Motion contrast OCT imaging was performed with the phase-variance OCT angiography method. A Fourier-domain mode-locked light source was used to enable an imaging rate of 1.7MHz. We experimentally demonstrate the challenges and advantages of wide-field OCT angiography (OCTA). In the discussion, we consider acquisition time, scanning area, scanning density, and their influence on visualization of selected features of the retinal and choroidal vascular networks. The OCTA imaging was performed with a field of view of 16deg (5 mm×5 mm) and 30deg (9 mm×9 mm). Data were presented in en face projections generated from single volumes and in en face projection mosaics generated from up to 4 datasets. OCTA imaging at 1.7MHz A-scan rate was compared with results obtained from a commercial OCTA instrument and with conventional ophthalmic diagnostic methods: fundus photography, fluorescein, and indocyanine green angiography. Comparison of images obtained from all methods is demonstrated using the same eye of a healthy volunteer. For example, imaging of retinal pathology is presented in three cases of advanced age-related macular degeneration.

Wide-Field OCT Angiography Investigation of the Relationship Between Radial Peripapillary Capillary Plexus Density and Nerve Fiber Layer Thickness.

PurposeTo characterize the density and distribution of the radial peripapillary capillary plexus (RPCP) and its relationship with retinal nerve fiber layer (NFL) thickness in healthy subjects.MethodsUsing spectral-domain optical coherence tomography (OCT), split-spectrum amplitude decorrelation angiography algorithm and automated montaging, wide-field OCT angiography (OCTA) was used to measure the RPCP capillary density (CD) and NFL thickness. Polar sector-average CD and thickness maps were also created on each eye.ResultsWide-field OCTA (8 × 8 mm) in 10 healthy eyes from 10 subjects demonstrated the distribution of the RPCP throughout the posterior pole. RPCP-CD decreases with distance from the disc, but along the arcuate nerve fiber bundles relatively dense (> half maximum density) RPCP extends more than 5 mm from the disc and includes regions superior to and inferior to the macula. The RPCP-CD and NFL thickness are highly correlated (R2 = 0.85, P < 0.001) and fit well with a nonlinear stacked-layer model. The model fit suggests that the RPCP is present when the NFL is thicker than 17.9 μm and reaches a ceiling area density of 84% and that the RPCP has an apparent volume density of 19% at the current instrument transverse resolution. This indicates that capillary overlap can be expected to occur when NFL thickness reaches 40 μm.ConclusionsThe wide distribution of dense overlapping RPCP suggests that wider (up to 8 mm vertical and 7 mm horizontal) OCTA scans may be better investigate capillary loss in the early stages of glaucoma or other optic neuropathies.

Types of diabetic retinopathy studied by wide field angiography

PurposeTo evaluate the types of diabetic retinopathy (DR) using a wide field fluorescein angiography and to identify the associated factors.MethodsIn a retrospective study, consecutive wide‐field angiographs obtained using the Heidelberg Retina Angiograph 2 with a contact lens system Staurenghi were graded in: anterior, posterior or diffuse diabetic retinopathy. Anterior DR was defined if diabetic retinal changes were noted only at the location anterior to the imaginary circle bordered by the Early Treatment Diabetic Retinopathy Study seven‐standard fields. In all patients central foveal thickness was measured on Spectral‐domain optical coherence tomography using Topcon 2000.ResultsA total of 69 eyes of diabetic patients were included. Diabetic retinopathy was anterior in 12 eyes (17.4%), posterior in 24 eyes (34.8%) and was diffuse in 33 eyes (47.8%). Retinal non perfusion was associated with anterior DR in 17.5%, posterior DR in 2.5% and diffuse DR in 80% of eyes (p &lt; 0.001). Peripheral vessel leakage was present in 14.3% of anterior DR, and in 85.7% of diffuse DR, and none eye in posterior DR (p &lt; 0.001). The average of central foveal thickness was 232 μm in anterior DR, 303 μm in posterior DR and 459 μm in diffuse DR (p = 0.01). No correlation was found between types of DR and age (p = 0.22), sex (p = 0.2), arterial hypertension (p = 0.12), cardiopathy (p = 0.16), nephropathy (p = 0.16) and dyslipidemia (p = 0.07).ConclusionsThis study highlighted that diffuse DR was significantly associated with retinal non perfusion and macular edema. Posterior DR was less associated with retinal non perfusion and peripheral vessel leakage. Eyes with anterior and diffuse DR are at greater risk of ocular complications, needing more clinical monitoring.

Peripheral Findings and Retinal Vascular Leakage on Ultra-Widefield Fluorescein Angiography in Patients with Uveitis

To compare ultra-widefield fluorescein angiography (UWFFA) with simulated conventional fluorescein angiography (FA) to evaluate peripheral pathology and leakage and correlate with clinical activity in patients with uveitis. Retrospective chart review. All uveitis patients initially evaluated with UWFFA (Optos 200Tx) between May 2012 and December 2013 were included in this study, including follow-up visits through August2014. Uveitis status was deemed as having active or inactive inflammation based on clinical examination. Changes to therapy, influence on management, and clinical diagnosis were also noted. UWFFA images were compared with simulated 50-degree FA images to evaluate for peripheral lesions, and leakage location was also graded. Imaging characteristics were then correlated with clinical information. Correlation of leakage on UWFFA with clinical inflammation. An initial set of 243 uveitis patients and a total of 1008 eye images were reviewed. When UWFFA was compared with a simulated 50-degree FA image, UWFFA added additional information regarding the presence of peripheral vascular leakage in 25%, peripheral nonperfusion in 14%, peripheral lesions in 6.6%, and peripheral neovascularization in 3.9% of patients. A total of 600 eye images exhibited fluorescein leakage, of which 21% displayed central leakage only, 11% had central and peripheral leakage, 31% had peripheral leakage only, and 37% had diffuse vascular leakage. Based on peripheral findings on widefield angiography, the treatment was changed in 69 patients (28%). Corresponding eye examinations were reviewed for each imaging session, and of 600 eye images with vascular leakage, 567 eye images were also clinically active, which was 95% sensitive as a surrogate indicator of clinical inflammation. Anterior chamber cell and vitreous haze also significantly correlated with leakage on widefield angiography. Retinal vascular leakage on UWFFA reveals increased pathology and leakage compared with conventional angiography, which can influence management, and accurately identifies and correlates with active inflammation in patients with uveitis. A more objective measure of inflammation in the form of leakage exhibited on UWFFA may help standardize treatment and care of patients with uveitis.

Comparison of Oral Versus Intravenous Fluorescein Widefield Angiography in Ambulatory Pediatric Patients

Purpose: To compare the image quality and clinical utility of oral versus intravenous (IV) dye administration for fluorescein widefield angiography in pediatric patients. Design: Retrospective observational case series. Methods: Retrospective chart review of pediatric patients who underwent noncontact widefield fluorescein angiography (FA; Optos plc) at a single tertiary referral center (UCHealth Eye Center, Aurora, Colorado) between January 1, 2014, and May 31, 2016. Fluorescein angiography images were de-identified, and FA timing was hidden. A masked retinal specialist graded FA image quality and clinical utility. Results: A total of 103 FAs (62 IV and 41 oral) in 82 patients were reviewed. Oral fluorescein administration was more common in young patients (mean age: 8.1 years) compared to IV administration (mean age: 14.5 years; P &lt; .001). Multivariate analysis with adjustment for age showed no statistical difference between oral and IV FA image quality ( P = .59). There was a high incidence of excellent clinical utility in both oral and IV FAs, with no statistically significant difference between the 2 methods. Subgroup analysis of familial exudative vitreoretinopathy, Coats’ disease, choroidal neovascular membrane, and uveitis also showed no statistical difference in clinical utility between IV and oral FA. Conclusion: Oral widefield FA had excellent clinical utility and comparable image quality to IV fluorescein widefield angiography (with adjustment for age). For the evaluation of pediatric retinal disease, oral FA can be a clinically useful diagnostic tool in pediatric patients who are intolerant to IV access, which may avoid some need for FA under general anesthesia.

Detection of posterior vortex veins in eyes with pathologic myopia by ultra-widefield indocyanine green angiography

AimsTo analyse the characteristics of posterior vortex veins detected in highly myopic eyes by wide-field indocyanine green angiography (ICGA).MethodsOne hundred and fifty-eight consecutive patients (302 eyes) with high myopia (myopic...

Standard versus widefield angiography in detecting new vessels in proliferative diabetic retinopathy

Purpose: The purpose of this study was to find out the accuracy of detecting new vessels (NVE) using standard field and widefield (SF and WF) angiographic imaging modality in eyes with proliferative diabetic retinopathy (PDR). Methods: This is a retrospective, cross-sectional study of 88 patients who underwent fundus fluorescein angiography (FFA) for suspected PDR from March 2015 to August 2015. Angiography was performed on the SPECTRALIS (Heidelberg, Germany) using SF 55° lens at primary, up, down, right, and left gaze and Staurenghi WF 102° lens in primary gaze. NVE were diagnosed by standard definition on FFA and a number of NVE were counted. Comparison of NVE detected on WF versus SF in primary gaze and WF versus SF in peripheral gaze was made. Fisher's exact t-test was used for statistical analysis. Results: The mean age of the patients was 56.87 ± 12.42 years. PDR was bilateral in 73 eyes and unilateral in 15 eyes. On comparing WF versus SF in primary gaze, 117 and 99 eyes were correctly detected as having NVE, respectively. On comparison of WF with SF in peripheral gaze, NVE picked up was 117 and 114 eyes, respectively. The missed NVE count in both comparisons was found to be statistically significant (P Conclusion: As evident by our study results, SF images in primary as well as all peripheral gazes tend to miss out on NVE, thereby incorrectly diagnosing PDR eyes as non-PDR, which were picked up on WF as having NVE. Hence, we propose that WF angiography can be considered as gold standard for accurately diagnosing the presence of NVE in eyes with PDR.

Contribution of wide field angiography to diabetic macular edema

PurposeTo evaluate diabetic macular edema in non proliferative diabetic retinopathy (NPDR) using a wide field fluorescein angiography.MethodsIn a retrospective study, consecutive wide‐field angiographs using the Heidelberg Retina Angiograph 2 with a contact lens system Staurenghi and SD‐OCT were performed in diabetic patients with non proliferative diabetic retinopathy.ResultsA total of 71 eyes in 39 diabetic, average age was 58 years (SD 12). Most of the patients had type 2 diabetes mellitus (92%) and average duration since diabetes diagnosis was 10 years. Mean HA1c was 7.4%. Distribution of NPDR severity was: mild NPDR in 6% of eyes, moderate NPDR in 21% and severe NPDR in 73%. Macular edema was found in 53%. A thicker retina was observed in eyes with peripheral non perfusion (353 vs. 254 μm p = 0.006). Retinal non perfusion was associated with macular edema (97 vs. 76%, p = 0.01) and poor visual acuity (p &lt; 0.001).ConclusionsDiabetic macular edema seems to be strongly associated with peripheral retinal non perfusion. So treatment and management of diabetic macular edema may be reconsidered using either a targeted laser treatment in the area of retinal non perfusion or anti‐VEGF intravitreal injection.