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Ella H. Leung, Gennady Landa, Richard Rosen; Cystoid Macular Edema and Peripheral Vascular Leakage on Ultra-Wide Field Fluorescein Angiography. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2071.
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To determine the relationship between macular edema and peripheral vascular leakage in the mid-peripheral and far peripheral retina using ultra-wide field fluorescein angiography.
An Optos P200 Scanning Laser Ophthalmoscope was used to obtain 200-degree fluorescein angiograms (FA) of the fundus in consecutive patients seen at the Retina Center in the New York Eye and Ear Infirmary. The ultra-wide field FAs and macular optical coherence tomography (OCTs) of 156 eyes in 99 patients with macular leakage were analyzed.
The most common past ocular histories for patients with cystoid macular edema (CME) were proliferative diabetic retinopathy (67%), central and branch retinal vein occlusion (18%), and exudative age-related macular degeneration (13%). The majority of eyes with macular leakage on FA and CME confirmed on OCT had fluorescein leakage in the mid-periphery (97%) and far periphery (90%) of the retina. Thirty-six eyes (23%) had greater leakage in the far periphery than in the central or mid-periphery, and two percent with CME and far peripheral leakage had no leakage in the posterior fundus. Fifty-six patients (56%) had bilateral leakage in the macula.
Macular edema is strongly associated with peripheral vascular leakage. In severe cases, the far peripheral retina and the contralateral eye should be thoroughly examined. Ultra- wide field angiograms are useful for detecting far peripheral leakage and may provide an earlier indication of the need for anti-vascular endothelial growth factor injections or pan-retinal photocoagulation.
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