Purchase this article with an account.
Giulio Barteselli, Jay Chhablani, Su Na Lee, Haiyan Wang, Igor Kozak, Lingyun Cheng, Dirk-Uwe Bartsch, William R. Freeman; Safety And Efficacy Of Oral Fluorescein Angiography In Detecting Macular Edema Compared To Spectral Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1171.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate safety of oral fluorescein angiography and to compare its efficacy in detection of macular edema to spectral-domain optical coherence tomography.
In a retrospective study, results of consecutive imaging studies for patients from the Jacobs Retina Center at University of California San Diego, who had simultaneously undergone both oral fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) by a confocal laser ophtalmoscope (cSLO Spectralis HRA, Heidelberg Engineering, Vista, CA) over a 42-month period were reviewed and graded by two independent masked retina trained specialists. The causes of macular edema included age-related macular degeneration (AMD), diabetic retinopathy (DR), retinal vein occlusion (RVO), uveitis, epiretinal membrane (ERM), macular hole (MH), post-surgical and other causes of macular edema (ME). Only one examination for each patient was analyzed if patients underwent multiple scans during the 42-month period.
1,019 simultaneous, good-quality examinations were included in the study (447 men, 572 women), for a total of 1,928 eyes. No severe or anaphylactic allergic reactions, vaso-vagal reactions or vomiting occurred after oral administration of the dye. A mild reaction of nausea was noted in less than 1% of the patients, and less than 0.5% of the patients noted a mild transient gastric discomfort. 1,581 eyes showed a retinal pathology, while 347 eyes were normal. Out of 1,928 eyes, 1,840 (95.4%) showed agreement between the two techniques. Sensitivity of SD-OCT for macular edema was 0.91 and that of oral FA was 0.97. Equivalent sensitivity was found only in case of wet AMD. Oral FA was more sensitive than SD-OCT in case of DR, ERM, RVO, uveitis and post-surgical ME. SD-OCT showed a higher sensitivity only in case of MH. A significantly higher FA grading was found in case of presence of ME at SD-OCT than in case of absence of ME (p<0.001).
Oral FA using a cSLO proved to be a safe, well-tolerated and sufficiently adequate technique to evaluate the presence of ME in most retinal diseases and it resulted to be more sensitive than SD-OCT in detecting low-grade ME. On the other hand, oral FA can fail to detect ME in some cases. Oral FA may be used as a safe alternative to IV FA but should not be considered an alternative to SD-OCT. On the contrary, we suggest performing a non-invasive examination using simultaneous oral FA and SD-OCT for clinical purpose, to obtain an accurate evaluation in the most common retinal diseases that cause ME.
This PDF is available to Subscribers Only