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Victor A Neamtu, Thomas R Friberg, Andrew W Eller; Identification and Management of Peripheral Retinal Ischemia in Intermediate Uveitis Using Ultra-Widefield Fluorescein Angiography. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6188.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the use of Optos Ultra-Widefield Fluorescein Angiography in the detection and treatment of peripheral ischemia in cases of Intermediate Uveitis.
A case series of 11 patients with a diagnosis of Intermediate Uveitis was retrospectively reviewed at our tertiary care center. Patients were included if they underwent fluorescein angiography via Optos Ultra-Widefield Scanning Laser Ophthalmoscope. Patients were excluded if the primary site of inflammation was in the anterior segment. Patient visual acuities and fluorescein angiography findings were recorded. The presence of peripheral capillary non-perfusion and extent in clock hours was recorded for each patient. Other sequelae of Intermediate Uveitis visualized via fluorescein angiography such as cystoid macular edema, peripheral retinal vascular phlebitis, disc leakage, and peripheral neovascularization were recorded.
2 out of 11 patients displayed severe peripheral capillary nonperfusion in the inferior retina with resultant retinal neovascularization. One patient underwent targeted panretinal photocoagulation in both eyes, treating areas of ischemic retina highlighted by the Optos imaging device. The other patient with peripheral neovascularization had very poor pupillary dilation which did not allow for laser treatment, and was instead treated with Avastin injections if there was active vitreous hemorrhage present. 4 of the remaining 9 patients had mild to moderate peripheral capillary nonperfusion, but without any evidence of peripheral neovascularization. These patients were observed only.
The Optos Ultra-Widefield Scanning Laser Ophthalmoscope has been studied in uveitic entities and has shown superiority at identifying peripheral retinal abnormalities as compared to standard fluorescein angiography cameras. Specifically, we demonstrate that areas of peripheral capillary nonperfusion can be easily imaged in cases of intermediate uveitis. This leads to the ability to provide targeted treatment in specific areas to treat retinal neovascularization and prevent sequelae of this disease such as vitreous hemorrhage. Further study is needed to see whether there is a correlation between peripheral capillary nonperfusion and the presence of cystoid macular edema.
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