June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Ultra-widefield Angiographic Assessment of Peripheral Ischemic Burden in Retinal Venous Occlusive Disease with Refractory Macular Edema
Author Affiliations & Notes
  • Jedediah McClintic
    Ophthalmology, Cleveland Clinic Cole Eye Institute, Cleveland, OH
  • Peter Kaiser
    Ophthalmology, Cleveland Clinic Cole Eye Institute, Cleveland, OH
  • Rishi Singh
    Ophthalmology, Cleveland Clinic Cole Eye Institute, Cleveland, OH
  • Sunil Srivastava
    Ophthalmology, Cleveland Clinic Cole Eye Institute, Cleveland, OH
  • Justis Ehlers
    Ophthalmology, Cleveland Clinic Cole Eye Institute, Cleveland, OH
  • Footnotes
    Commercial Relationships Jedediah McClintic, None; Peter Kaiser, Allegro Ophthalmics (C), Alcon (C), Novartis (C), Bayer (C), Regeneron (C), Genentech (C), Ophthotech (C); Rishi Singh, Genentech (C), Alcon (C), Bausch and Lomb (R), Zeiss (R), Quark Pharmaceuticals, Inc. (F); Sunil Srivastava, Bausch and Lomb (F), Bausch and Lomb (C), Novartis (F), Allergan (F); Justis Ehlers, Provisional patents filed related to intraoperative OCT technology. No company relationships (P)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 17. doi:
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      Jedediah McClintic, Peter Kaiser, Rishi Singh, Sunil Srivastava, Justis Ehlers; Ultra-widefield Angiographic Assessment of Peripheral Ischemic Burden in Retinal Venous Occlusive Disease with Refractory Macular Edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):17.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To assess peripheral retinal ischemia using ultra-widefield fluorescein angiography (FA) in patients with retinal vein occlusions and associated macular edema

Methods: A retrospective consecutive case series of patients with retinal vein occlusions and concomitant ultra-widefield FA was performed. The Optos 200Tx system was utilized to perform the ultra-widefieldimaging. Quantitative analysis of ischemic burden was performed in images of sufficient quality to allow for image processing. Areas of ischemia were identified and measured against the total area. The ratio of ischemic retina to total imaged retina was computed. Ischemia values for eyes with macular edema were compared to eyes without macular edema. Correlation between ischemic values and central macular thickness was also performed.

Results: Twenty-three eyes of 23 patients diagnosed with central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) were identified that underwent ultra-widefield FA. Variable amounts of peripheral and/or macular ischemia were identified in 100% of eyes. For quantitative analysis, angiograms of 12 eyes were of sufficient quality to allow for measurement of ischemic areas. Reasons for limited quality included insufficient area visualized, artifacts (e.g, eyelashes), and poor focus. The mean ischemic burden in eyes with CRVO and macular edema was 40.8% of the visualized retina. In eyes previously treated with panretinal photocoagulation, significant residual ischemic burden was present in both CRVO (17.2%) and BRVO (11.9%). Ischemic values of all patients with macular edema were significantly higher than those without macular edema (p=0.03). There was a direct correlation between increasing ischemic burden with increasing central macular thickness (r=0.873, p=0.002)

Conclusions: Peripheral ischemic burden is associated with increased macular edema in retinal venous occlusive disease. Peripheral ischemia is a common finding in both CRVO and BRVO. The relationship between area of peripheral ischemia to vascular endothelial growth factor load; and ultimately, to macular edema is yet to be clarified and provides future areas for research

Keywords: 550 imaging/image analysis: clinical • 688 retina • 505 edema  
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