Ultra-wide field fundus fluorescein angiography in rhegmatogenous retinal detachment

Abstract

 

Purpose

 

Ultra-wide field fundus (UWF) imaging allows assessment of 2000 fundus thereby facilitating analysis of peripheral retina. We sought to assess UWF fluorescein angiographic (UWFA) characteristics of rhegmatogenous retinal detachments (RRD), a predominantly peripheral retinal pathology.

 

Methods

 

We enrolled 30 consecutive eyes clinically diagnosed with RRD and studied their angiographic features using UWFA (200Tx™, Optos PLC, Dunfermline Scotland, United Kingdom).

 

Results

 

The age range of patients was 8 to 64 years with 17 (56.67%) having RRD duration of less than 8 days and 13 (43.33%) with history of more than 8 days. 14 (46.67 %) patients had previous history cataract surgery, 6 (20%) were myopes, 2 (6.67%) had giant retinal tears, 3 (10%) were post-traumatic, 2 (6.67%) had iridofundal coloboma and remaining 3 (10%) had miscellaneous associations. Salient angiographic findings included paravascular changes such as venous dilatation (100%), paravascular leak (100%), peripheral capillary non-perfusion (CNP) (100%), vascular tortuosity (73%), minimal disc leak (46.67%) and neovascularisation elsewhere (26.7%). The edge of break could be identified by multiple small hyperfluorescent knob-like points along it (“street-lamps along a city-road appearance”). Additionally sub-retinal proliferative vitreo-retinopathy (PVR) changes (23.33%) were noted as blocked patterns of hypo-fluorescence.

 

Conclusions

 

UWF technology efficiently images peripheral retina. Angiographic features such as venous dilatation, paravascular leak, peripheral CNP are seen in almost all RRD cases. Vascular tortuosity, neovascularisation, minimal disc leak, patterned break and sub-retinal PVR, though relatively inconsistent are other associated important features of RRD. These features help in understanding the pathophysiology of detached retina and would provide valuable inputs while analyzing and managing exudative retinal detachments.  

 

Ultra-wide field colour fundus photograph patient no 14. (age 14 years, duration 16 days) showing total rhegmatogenous retinal detachment with a large temporal break.

 

 

Ultra-wide field fundus fluorescein angiographic image at 3 minutes in patient no.14 demonstrating vascular changes (venous dilatation, vascular tortuosity, paravascular leak, peripheral capillary non-perfusion areas). The retinal break is highlighted by knob-like vascular hyperfluorescent ends: “street-lamps along a city-road appearance”.