Iris fluorescein angiography in diabetic vitrectomy patients

Summary Preoperative iris fluorescein angiograms (IFA) and ophthalmic records of 34 diabetic patients who underwent vitrectomy were reviewed. Of 24 patients without clinically apparent rubeosis, 23 showed evidence of iris microvascular abnormalities or rubeosis on IFA. Patients with rubeosis (Grades III and IV) on IFA had a 63% incidence of postoperative neovascular glaucoma, thus isolating them as a high risk group. The visual outcome of patients developing neovascular glaucoma was poor.

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Zusammenfassung Präoperative Fluoreszeinangiogramme der Iris von 34 Diabetikern, an denen eine Vitrektomie durchgeführt wurde, wurden mit dem postoperativen Verlauf verglichen. 23 von 24 Patienten, bei denen klinisch keine Rubeosis festgestellt wurde, zeigten Gefäßveränderungen im Angiogramm. Patienten mit eindeutiger Rubeosis im Angiogramm (Grad III and IV) bekamen in 63% der Fälle ein Sekundärglaukom. Sie gehören damit in eine hohe Risikogruppe. Der postoperative Visus bei den Patienten mit Glaukom war schlecht.

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This investigation was supported in part by the Public Health Research Grant EY00841 from the National Eye Institute of Health, Bethesda, Maryland and the Heed Ophthalmic Foundation, Chicago, Illinois     

Light flashbacks during retinal laser photocoagulation following fluorescein angiography.

BACKGROUND AND OBJECTIVE: Yellow light flashbacks can often be seen in cases of laser photocoagulation performed shortly after fluorescein angiography. To determine whether unblocked secondary emission from retained aqueous and vitreous fluorescein may be reaching the treating ophthalmologist, the absorption characteristics of serial dilutions of sodium fluorescein were studied at wavelengths similar to the output of the krypton laser. MATERIALS AND METHODS: A Unicam sp500 series II visible spectrophotometer (Pye Unicam Ltd., Cambridge, UK) was used to measure fluorescein absorption at serial dilutions ranging from 100,000,000 to 100 ng/mL at 488, 518, 568, and 647 nm. sive dilution of fluorescein concentration and with increased wavelength. Blue (488 nm) and green (518 nm) light absorbed at all dilutions of fluorescein. Yellow light (568 nm) did not show any significant absorption below a concentration of 100,000 ng/mL and red light (647 nm) absorbed little below a concentration of 3,000,000 ng/mL. CONCLUSIONS: Dilutions of fluorescein absorbed all commonly used laser wavelengths. There is concern that fluorescein absorption results in emission of light at 520 nm (range: 450 to 700 nm), which may not be blocked by the filters currently placed in fixed laser delivery systems.     

Stereoscopic fluorescein angiography in diabetic maculopathy

PURPOSE: To explore the possible differences in the depth location of microaneurysms in focal as well as diffuse diabetic macular edema. METHODS: The density of superficial and deep retinal microaneurysms was assessed using a stereoscopic fluorescein angiographic method. RESULTS: The density of deep retinal microaneurysms was nearly identical in the group with diffuse macular edema (89.9 +/- 28.5 microaneurysms/test grid) and the group with focal macular edema (90 +/- 65.4 microaneurysms/test grid). The density of superficial retinal microaneurysms was significantly lower in the group with diffuse macular edema (22.8 +/- 12.5) than in the group with focal macular edema (47.9 +/- 30.6). The density fraction of superficial retinal microaneurysms was lower in the group with diffuse macular edema (0.19 +/- 0.07) than in the group with focal macular edema (0.36 +/- 0.14). In the group with focal macular edema, areas without edema had a significantly lower density of superficial (6.1 +/- 2.8) and deep (15.6 +/- 7.8) retinal microaneurysms than did areas with edema (superficial: 47.9 +/- 30.6; deep: 90.0 +/- 65.4). In the group with focal macular edema, the density fraction of superficial retinal microaneurysms was nearly identical in areas with (0.36 +/- 0.14) and areas without (0.30 +/- 0.10) edema. CONCLUSION: The development of focal macular edema might be linked to the density of microaneurysms. Diffuse macular edema might be a result of some unknown effect on the deeper retina and/or the choroid.     

Oral fluorescein angiography with the scanning laser ophthalmoscope in diabetic retinopathy: a case controlled comparison with intravenous fluorescein angiography

AIM: To compare the performance of oral fundus fluorescein angiography with a confocal scanning laser ophthalmoscope (SLO) with intravenous fundus fluorescein angiography (IVFFA) with a fundus camera in the assessment of sight-threatening diabetic retinopathy. PATIENTS AND METHODS: A total of 25 patients undergoing IVFFA to investigate their diabetic retinopathy were recruited. Participants returned 1 week later and an oral angiogram with the SLO was performed. Six facets of the oral and intravenous angiograms were scored and compared: visualization of the foveal avascular zone (FAZ); branch retinal identification; macular leakage; identification of microaneurysms in areas of macular leakage; peripheral nonperfusion, and leakage from neovascular complexes. RESULTS: Compared to IVFFA, the FAZ was unreliably visualized with oral angiography (Kappa 0.1, 95% CI 0-0.3). In contrast, macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), identification of microaneurysms in areas of macular leakage (Kappa 0.78, 95%, CI 0.72-0.83), and neovascular complexes (Kappa 1.0) were reliably seen. Analysis of the visualization of peripheral nonperfusion was complicated by the finding that profuse dye leakage from neovascular complexes obscured the view of the peripheral retina. If the five angiograms in which this occurred were excluded, oral angiography identified 23 of the 24 eyes in which significant nonperfusion was found on IVFFA. CONCLUSION: Oral angiography with the SLO can provide high-quality angiograms that allow judgments to be made about the presence of treatable diabetic maculopathy, proliferative diabetic retinopathy, and peripheral nonperfusion. In the presence of coexisting macular oedema, it proved to be an unreliable technique with which to investigate foveal ischaemia.     

虹膜荧光血管造影联合眼底荧光血管造影在全视网膜激光光凝术后糖尿病视网膜病变患者中的应用研究

目的　探讨虹膜荧光血管造影（ｉｒｉｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＩＦＡ）联合眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）检查在全视网膜激光光凝术后（ｐａｎｒｅｔｉｎａｌｐｈｏ-ｔｏｃｏａｇｕｌａｔｉｏｎ,ＰＲＰ）增生型糖尿病视网膜病变患者中的临床应用。方法　对ＰＲＰ术后的６５例１２３眼增生型糖尿病视网膜病变患者均行视力、眼压、裂隙灯、ＩＦＡ联合ＦＦＡ检查。采用非参数检验法对比分析裂隙灯和ＩＦＡ检测虹膜新生血管灵敏性的差异。结果　ＦＦＡ显示１２３眼中,２１眼视网膜无灌注区,３９眼视网膜新生血管,１２眼玻璃体积血和３２眼黄斑水肿。ＩＦＡ显示１２３眼中,９７眼无糖尿病虹膜病变,１３眼非增生型虹膜病变,１１眼增生型虹膜病变,２眼新生血管性青光眼。所有非增生型虹膜病变眼不能被裂隙灯发现,能被ＩＦＡ检测。ＩＦＡ检查发现虹膜新生血管眼（１１眼）比裂隙灯检查（５眼）更灵敏（Ｐ＝０．０３）。结论　ＩＦＡ联合ＦＦＡ检查能及早发现ＰＲＰ术后的增生型糖尿病视网膜病变合并糖尿病虹膜病变患者,为及时治疗提供帮助。     

The importance of fluorescein angiography in planning laser treatment of diabetic macular edema

OBJECTIVE: To test the hypothesis that pretreatment fluorescein angiography (FA) is not necessary for effective laser treatment of patients with clinically significant diabetic macular edema (CSME). DESIGN: Prospective, randomized, controlled treatment simulation. PARTICIPANTS: Six fellowship trained retina specialists. INTERVENTION: The authors compared the ability of four retina specialists (observers) to plan laser treatment with and without the use of FA. One hundred consecutive cases of CSME were selected, each case consisting of a stereo pair of color photographs and a corresponding fluorescein angiogram. These cases were first read by two retina specialists who reached consensus on a treatment plan for each case (standard map). Each of the 4 observers reviewed 50 of these cases on 2 occasions and plotted 2 sets of treatment maps, 1 set created with and 1 without the aid of FA. Each observer's 100 treatment maps were graded for accuracy by comparing them to the corresponding standard maps. The role of FA in improving the accuracy of treatment maps was evaluated using logistic regression analysis to control for different observers, different cases, and different posterior pole characteristics. MAIN OUTCOME MEASURES: Accuracy was defined as the proportion of standard treatment correctly treated by the observer. RESULTS: For the observers as a group, the use of FA improved treatment planning accuracy from 49% to 54.5% (P = 0.02); however, there was significant interobserver variation in performance (P < 0.001). Treatment planning accuracy without and with FA was as follows: observer 1, 40.8% and 40.2%; observer 2, 49.8% and 72%; observer 3, 56.1% and 59.5%; and observer 4, 49.2% and 46.4%. CONCLUSION: The use of FA improves the accuracy of treatment planning for CSME. The authors' study supports the use of FA in laser treatment of patients with CSME.     

Convulsion following intravenous fluorescein angiography.

Tonic-clonic seizures followed intravenous fluorescein injection for fundus angiography in a 47-year-old male. Despite precautions this adverse reaction recurred on re-exposure to intravenous fluorescein.     

眼底无可见视网膜病变糖尿病患者的荧光血管造影

目的探讨糖尿病患者检眼镜下未见到视网膜病变的荧光血管造影表现。方法对常规眼底检查未见到视网膜病变的糖尿病患者进行眼底荧光血管造影。结果荧光血管造影正常44只眼,与眼底所见符合率为35.48%;异常表现共80只眼占64.52%,其表现主要为微血管瘤,视网膜毛细血管扩张和毛细血管无灌注等。结论眼底镜下未发现视网膜病变的糖尿病患者,眼底荧光造影出现了微血管瘤,视网膜毛细血管扩张等改变。     

荧光素虹膜血管造影联合眼底血管造影在DR合并新生血管性青光眼中的应用

背景 新生血管性青光眼(NVG)是由视网膜缺血缺氧继发的眼病.荧光素虹膜血管造影(IFA)可早期诊断NVG,但其不能全面反映眼底血管情况.IFA联合荧光素眼底血管造影(FFA)可全面检测视网膜及虹膜新生血管情况,但目前国内关于糖尿病视网膜病变(DR)合并NVG患者中此方法的应用研究较少. 目的 探讨IFA联合FFA检查在增生性糖尿病视网膜病变(PDR)患者合并新生血管性青光眼的临床应用.方法 采用回顾性研究方法.纳入2013年2月至2016年1月在河南省立眼科医院接受IFA和FFA联合检查的PDR患者79例133眼,其中无虹膜病变100眼,I期青光眼红变期21眼,Ⅱ期开角型NVG 12眼.所有患眼均行视力、眼压、裂隙灯显微镜、IFA联合FFA检查.采用McNemar非参数检验法对比分析裂隙灯显微镜和IFA检查在I期青光眼红变期患眼检出率的差异. 结果 IFA检查显示100眼无虹膜病变患者无异常虹膜荧光素渗漏,FFA检查显示接受全视网膜激光光凝术(PRP)治疗的32眼未发现视网膜新生血管,68患眼存在视网膜新生血管;早期IFA检查显示,21眼I期青光眼红变期患者瞳孔缘或虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管;早期IFA检查显示12眼NVG患者虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管.I期青光眼红变期患眼中IFA检查的检出率为100％(21/21),明显高于裂隙灯显微镜检查的71.43％(15/21),2种检测方法检出率的比较差异有统计学意义(P=0.03). 结论 IFA联合FFA检查可以及早发现PDR合并青光眼红变期,有助于及时指导治疗.     

Oral fluorescein angiography with scanning laser ophthalmoscope

Objective: To study the efficacy of oral fluorescein angiography compared to intravenous (IV) fluorescein angiography in several retinal diseases.Patients and methods: We performed oral fluorescein angiography with a confocal SLO (Heidelberg Retina Angiograph-HRA) in fourteen psychologically challenged individuals and children, all of whom explicitly refused venipuncture. Patient's diagnosis included diabetes, central serous choroidopathy, toxoplasmosis and choroidal neovascularization. A dose of30 mg/kg body weight of fluorescein was given. Results: We obtained images of adequate quality to allowinterpretation in all cases.Conclusions: Even though the images were not nearly as good as when obtained after IV injection, we conclude that oral fluorescein angiography with SLO is an appropriate alternative in those cases where a venipuncture is contraindicated by medical or psychological reasons.     

Topography of diabetic macular oedema compared with fluorescein angiography

PURPOSE: To compare the amount and pattern of fluorescein leakage in diabetic macular oedema with the retinal thickness maps obtained with the retinal thickness analyser (RTA) and optical coherence tomography (OCT). METHODS: A consecutive series of 30 eyes from 30 patients with diabetic macular oedema was included. On fluorescein angiography (FA) the macula was analysed in 10 subfields as defined by the ETDRS. The amount and source of leakage for each field were determined. Retinal thickness was measured by OCT and RTA maps in each of the 10 fields and compared with the FA grading. RESULTS: Foveal retinal thickness on OCT was most influenced by the overall FA leakage, which was the only significant covariate on multivariate analysis. The source and amount of leakage correlated significantly with the topography of retinal thickness in the four peripheral fields between 1500 microm and 3000 microm from the macular centre (r = 0.54, p = 0.002). The mean amount and source of leakage in those fields also showed the highest correlation with central macular thickness on OCT (r = 0.46, p = 0.01). Similar results were obtained by RTA when excluding ischaemic cases (r = 0.44, p = 0.04). For both instruments, FA leakage within the four central fields < 1500 microm did not correlate significantly with retinal thickness. Thickness by OCT and RTA were highly correlated with one another for central macular measurements (r = 0.73, p < 0.001), but correlated poorly in the peripheral fields. Overall, OCT measurements correlated more highly with FA. CONCLUSIONS: Optical coherence tomography and RTA thickness measurements can be used to identify patients for further examination. Fluorescein angiography leakage in the outer ETDRS fields correlates best with central thickness and retinal thickness topography by OCT.     

荧光素眼底血管造影在糖尿病性视网膜病变中的应用价值

目的评价荧光素眼底血管造影（FFA）在糖尿病性视网膜病变（DR）诊断分期和指导治疗方面的价值。方法采用FFA对182例（364只眼）糖尿病患者进行筛查,对DR临床分期进行修正,并根据FFA的分期指导治疗。结果12只眼眼底检查未发现有DR的患者FFA显示有Ⅰ期微血管瘤病变;25只眼Ⅰ-Ⅱ期患者FFA显示更多的微血管瘤及合并黄斑水肿改变;11只眼Ⅲ期患者FFA显示毛细血管无灌注区范围比检眼镜下检出棉絮斑范围广,13只眼出现新生血管改变;20只眼Ⅳ期患者检出比检眼镜下更多的新生毛细血管及黄斑水肿改变。结论FFA是作为DR分期的最佳标准,且为指导激光治疗和评定光凝疗效的指标。     

Peripheral neovascularization of the retina in diabetic retinopathy: fluorescein angiography classification and results of panretinal laser treatment

The prospective study reported here was based on 105 diabetic eyes with "new vessels elsewhere" (NVE), treated exclusively by panretinal laser application and followed up for 2.5 to 4 years. Fundus angiography was performed before treatment. The eyes were then classified in four categories according to the extent and location of capillary nonperfusion responsible for the NVE, namely 1) generalized ischemia (Type A); 2) extensive midperipheral ischemia (Type B); 3) moderate midperipheral ischemia (Type C); and 4) peripheral ischemia (Type D). Analysis of the neovascularization distribution pattern showed that NVE alone existed only in Type D, whereas in the other three types the neovascularization was present either only in the retina or in both the retina and the optic disk. This mixed vascularization was 100% in Type A, 71% in Type B, 31% in Type C, and nonexistent in Type D. Statistical analysis revealed a significant correlation between the type of ischemia and the location of the new vessels. The therapeutic results 3-4 months, 1 year, and 2.5-4 years after intervention showed a significant trend toward an increase in the number of eyes with recurrences when moving from Type D to Type A. This means that the prognosis of NVE after panretinal laser coagulation depends mainly on the type of retinal ischemia. The poorest prognosis is that for generalized ischemia (Type A), followed in descending order by Types B, C, and D. The critical period for increased recurrence in cases which initially responded positively to treatment is primarily in the first 3-4 months following the intervention.     

眼底彩色照像与荧光素眼底血管造影对判断糖尿病视网膜病变临床分期的一致性研究

目的 探讨眼底彩色照像与荧光素眼底血管造影(FFA)对判断糖尿病视网膜病变(DR)临床分期的一致性.方法 为系列病例研究.选择行FFA检测的99例(188只眼)糖尿病患者,均经眼底镜检查除外轻度非增生性糖尿病视网膜病变(NPDR)和严重增生性视网膜病变(PDR).所有患者在行FFA检测之前,拍摄眼底彩色照片,每只眼获得5张非立体、50°角视野的眼底彩色照片.根据DR国际临床分类法,对从眼底彩色照片和FFA图像获得的DR临床分期结果进行一致性比较.结果 眼底彩色照像诊断中度NPDR 59只眼(31.4%),重度NPDR 76只眼(40.4%);PDR53只眼(28.2%);FFA检测诊断中度NPDR 50只眼(26.6%),重度NPDR 72只眼(38.3%);PDR66只眼(35.1%).眼底彩色照像与FFA检测在判断DR临床分期方面具有相对的一致性(κ=0.601),在判断是否需要进行全视网膜光凝即达到重度NPDR和PDR方面,两者的一致性相对较高(κ=0.652).结论 眼底彩色照像(5张50°角视野)可以为DR患者全视网膜光凝治疗提供有力依据,FFA检测能够更早、更准确地判断DR病程.     

糖尿病性视网膜病变眼底荧光血管造影分析

目的探讨糖尿病性视网膜病变(DR)的毛细血管无灌注区(NP)的分布特点及黄斑病变的发病特点。方法回顾分析DR患者126例(239只眼)应用眼底荧光血管造影(FFA)的检查资料,分析NP的分布特点及黄斑病变特点。结果在126例中,有75例(102只眼)存在NP,NP发生于视网膜鼻侧、下方、上方及颞侧的发生率分别为81.37%、71.57%、60.78%及53.92%,发生于中周部、周边部、后极部分别为84.31%、42.15%及14. 70%。黄班病变出现56例(96只眼),占41.17%,其中局限性黄斑水肿占21.87%,弥漫性黄斑水肿占48.96%,囊样水肿占22.92%,缺血性黄斑病变占66.25%。结论视网膜中周部及鼻侧象限是NP最常发的部位,黄斑病变随着DR程度加重而加深,但没有严格对应关系。     

糖尿病黄斑病变的荧光血管造影特征与分型探讨

目的 分析糖尿病黄斑病变的眼底荧光血管造影特征，探讨糖尿病黄斑病变分型在该病诊断和治疗中的价值。方法 对484例（651眼）糖尿病视网膜病变患者进行眼底荧光血管造影检查，根据造影结果将糖尿病视网膜病变分为6期、糖尿病黄斑病变分为5型，并观察糖尿病黄斑病变分型与糖尿病视网膜病变（DR）分期的关系，以及在糖尿病黄斑病变诊断和治疗中的作用。结果 在DR的各不同时期均发生了程度不等的黄斑病变，651只DR眼中有389眼发生黄斑病变，占59.8%；黄斑病变的发生、发展和变化与一般的DR时相元相关规律性，DR和糖尿病黄斑病变的发展不完全同步。结论 糖尿病黄斑病变应用眼底荧光血管造影诊断和分型，其结果敏感而可靠，分型与治疗及预后明显相关。