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Adriana M. Ramirez, Gad Heilweil, Steven D. Schwartz, Jean-Pierre Hubschman, Scott Oliver, Irena Tsui; Increased Ischemic Index Correlates with Neovascularization in Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1037.
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To study angiographic retinal non-perfusion in diabetic retinopathy (DR) and explore its association with retinal neovascularization.
Retrospective, observational case series. An imaging database of angiograms performed at a single academic institution was searched for patients with the diagnosis of DR. Ultra wide field fluorescein angiograms were graded with a previously published protocol for quantifying retinal non-perfusion by calculating an ischemic index (ISI), the presence of retinal neovascularization, and the presence of angiographic macular leakage. Charts were reviewed for demographic and clinical information.
Twenty seven patients were identified and 42 eyes studied; mean patient age was 63 years (SD 22, range 25-92). The mean ISI in all eyes was 34.81% (SD 27, range 1-99). The mean ISI in non-proliferative DR eyes was 15% +/- 21% (range 0%-74%). The mean ISI in proliferative DR eyes was 49% +/- 21% (range 21%- 98%). Increasing ISI was significantly correlated to retinal neovascularization (p>0.0001). An ISI>21% was 100% sensitive and 83% specific for the presence of retinal neovascularization
Ultra wide field fluorescein angiography provides visualization of retinal non-perfusion in eyes with DR. Eyes which had retinal neovascularization at the time of the angiography were found to have significantly larger areas of retinal non perfusion as evidenced by a higher ISI compared to eyes without retinal neovascularization.
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