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Carlos Medina-Mendez, Matthew Kaufman, Andrew Eller, Thomas Friberg; Correlation of Posterior Inflammatory Leakage and Cystoid Macular Edema with Retinal Pigment Epithelium Atrophy in Retinitis Pigmentosa Evaluated with Optos Wide-field Fluorescein Angiography and Spectral Domain OCT. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4908.
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To utilize an Optos P200A (Dunfermline, Scotland) wide-field fluorescein angiographic (FA) system and SD-OCT to determine what characteristic changes in retinal pigment epithelium (RPE) atrophy correlate with posterior inflammatory changes in patients with retinitis pigmentosa (RP).
Patients diagnosed with RP who had been evaluated with Optos wide-field FA and SD-OCT were identified through a search of billing records. Two masked retina faculty members analyzed the images for the presences of late phase diffuse leakage as well as, amount, and location of RPE atrophy. RPE atrophy was classified as mild (< 33 %), moderate (33-66 %) and severe ( > 66%) depending on what percent of the total RPE area was involved. The location was determined as predominantly posterior, peripheral or diffuse. Leakage was graded subjectively as mild, moderate or severe. SD-OCT was used to determine the amount of macular atrophy and the presence of cystoid macular edema (CME).
A total of 39 eyes in 21 patients were analyzed. CME was found in 81% (13/16), 35% (7/20) and 0% (0/3) of patients with mild, moderate and severe RPE atrophy respectively. CME was seen in 66% (10/15) of patients with predominantly peripheral RPE changes, but was found in only 44% (7/16) and 37% (3/8) of eyes when predominantly diffuse or predominantly posterior RPE atrophy was observed. Leakage was observed in 19 of 39 eyes (35%). In eyes where leakage was observed, macular atrophy correlated with the amount of leakage seen on wide-field fluorescein angiography. A MCV of 11.98, 10.45, and 9.42 was seen in eyes with mild, moderate and severe leakage respectively. Interestingly the average MCV of non-leaking eyes was only 9.45.
Eyes with mild RPE atrophy where more likely to have CME. The location of the RPE atrophy is important as eyes with peripheral atrophy are more likely to have CME that those with posterior or diffuse atrophy. Macular atrophy correlated with late stage vascular leakage on FA. Further studies are needed to identify the prevalence, mechanism, treatment, and effect on prognosis of these findings but selectively performance of Optos wide-field FA and SD-OCT on these patients could be a valuable assessment tool.
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