June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Histopathologic Features of Diabetic Microangiopathy Imaged Using an Adaptive Optics Scanning Laser Fluorescein Angiography
Author Affiliations & Notes
  • Richard Rosen
    Ophthalmology, New York Eye & Ear Infirmary, New York, NY
    Ophthalmology, New York Medical College, Valhalla, NY
  • Alfredo Dubra
    Ophthalmology, Medical College of Wisconsin, Milwaukee, WI
  • Rishard Weitz
    Ophthalmology, New York Eye & Ear Infirmary, New York, NY
  • Joseph Carroll
    Ophthalmology, Medical College of Wisconsin, Milwaukee, WI
  • Michael Dubow
    Ophthalmology, New York Eye & Ear Infirmary, New York, NY
    Ophthalmology, Mount Sinai School of Medicine, New York, NY
  • Alexander Pinhas
    Ophthalmology, New York Eye & Ear Infirmary, New York, NY
    Ophthalmology, Mount Sinai School of Medicine, New York, NY
  • Nishit Shah
    Ophthalmology, New York Eye & Ear Infirmary, New York, NY
  • Yusufu Sulai
    Ophthalmology, Medical College of Wisconsin, Milwaukee, WI
    Ophthalmology, University of Rochester, Rochester, NY
  • Nicole Scripsema
    Ophthalmology, New York Eye & Ear Infirmary, New York, NY
    Ophthalmology, New York Medical College, Valhalla, NY
  • Joseph Walsh
    Ophthalmology, New York Eye & Ear Infirmary, New York, NY
    Ophthalmology, New York Medical College, Valhalla, NY
  • Footnotes
    Commercial Relationships Richard Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C); Alfredo Dubra, US Patent No: 8,226,236 (P); Rishard Weitz, None; Joseph Carroll, Imagine Eyes, Inc. (S); Michael Dubow, None; Alexander Pinhas, None; Nishit Shah, None; Yusufu Sulai, None; Nicole Scripsema, None; Joseph Walsh, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 6065. doi:https://doi.org/
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      Richard Rosen, Alfredo Dubra, Rishard Weitz, Joseph Carroll, Michael Dubow, Alexander Pinhas, Nishit Shah, Yusufu Sulai, Nicole Scripsema, Joseph Walsh; Histopathologic Features of Diabetic Microangiopathy Imaged Using an Adaptive Optics Scanning Laser Fluorescein Angiography. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6065. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To describe the fluorescein angiographic features of diabetic microangiopathy lesions imaged with an adaptive optics scanning light ophthalmoscope (AOSLO) compared to their appearance on conventional fundus photography and spectral domain optical coherence tomography (SDOCT).

 
Methods
 

AOSLO images (790nm; 1° degree field of view) without fluorescein dye were collected in 15 adult diabetic retinopathy patients to identify microvascular points of interest. Patients then ingested 1gm fluorescein dye mixed in 4oz of orange juice. Simultaneous reflectance (790 nm) and fluorescence (488 nm excitation, 503-548 nm emission) AOSLO images (1° field of view) were collected between 15 and 60 minutes post-ingestion. For comparison with conventional imaging techniques, fundus imaging with and without intravenous fluorescein were performed.

 
Results
 

In the fluorescence AOSLO channel we were able to visualize microangiopathic features of diabetic microangiopathy in vivo at the level of the retinal capillary bed. A number of lesions were clearly delineated, including a variety of microaneurysms, capillary loops, IRMA, and neovascularization, which could not be seen well in the 790nm channel. These lesions typically appeared as red dots on fundus photography or bright spots on clinical fluorescein angiography. OCT appearances were typically less distinct.

 
Conclusions
 

Micro fluorescein angiography can by successfully and safely achieved using AOSLO in diabetic patients revealing anatomic features previously seen only on pathology slides. This level of clinical imaging may prove useful for evaluating the impact of treatment at a the microscopic scale.

 
 
Figure 1. A:Segment of wide field fundus photograph demonstrating microaneurysms, tortuosity, and neovascularization. B:Standard wide field fluorescein angiogram with color coded frames corresponding to micro angiographic images in figure 2. C:Corresponding SD-OCT slice through the red frame revealing microaneurysms
 
Figure 1. A:Segment of wide field fundus photograph demonstrating microaneurysms, tortuosity, and neovascularization. B:Standard wide field fluorescein angiogram with color coded frames corresponding to micro angiographic images in figure 2. C:Corresponding SD-OCT slice through the red frame revealing microaneurysms
 
 
Figure 2. AOSLO FA images corresponding to frames in figure 1 revealing details of microangiopathy including vascular loops (A,B,C) microaneurysms(A,B,C), and capillary dropout( A, B,C).
 
Figure 2. AOSLO FA images corresponding to frames in figure 1 revealing details of microangiopathy including vascular loops (A,B,C) microaneurysms(A,B,C), and capillary dropout( A, B,C).
 
Keywords: 550 imaging/image analysis: clinical • 499 diabetic retinopathy • 688 retina  
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