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Kathleen Farhang, Kimberly Baynes, Francesco Pichi, Careen Y Lowder, Sunil K Srivastava; Ultra-widefield fluorescein angiography and the management of uveitis patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6184.
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Ultra-widefield fluorescein angiography (UWFFA) is an emerging technology that allows for improved visualization of the retinal periphery. The additional information offered by retinal periphery visualization may alter diagnosis, management, and treatment of many retinal conditions.
An IRB approved retrospective, observational consecutive case series of ophthalmic patients with uveitis at the Cleveland Clinic Foundation Cole Eye Institute was performed. All patients underwent comprehensive ophthalmic exam and UWFFA with the Optos 200Tx system. High magnification views were compared to the ultra-widefield FA to simulate standard 50-degree fundus images. Any findings outside the range of a standard fluorescein angiogram were documented. Determination of inflammatory activity was based on review of the clinical exam.
254 patients with uveitis that required fluorescein angiography were included in the study. A total of 535 visits resulted in 1053 sets of ultra-widefield FA images. 75.6% of ultra-widefield images yielded information that would not have been found with standard imaging technology. Retinal findings outside the standard FA view included: peripheral non-perfusion (28.7%), focal vessel leakage (38.2%), diffuse leakage (63.8%), multifocal lesions (15.4%), window defects (17.3%), and neovascularization (7.5%).<br /> <br /> The 628 (59.6%) eye images identified with fluorescein leakage on UWFFA were classified into leakage patterns: central leakage (13.1%), central and peripheral leakage (5.9%), diffuse leakage (22.5%), and peripheral leakage only (18%). Of the 607 eye images deemed clinically active, 100% had leakage on UWFFA. Of the 415 eye images deemed clinically inactive, only 21 (5%) demonstrated leakage.<br /> <br /> In 27% of patients, UWFFA impacted decisions on therapy. UWFFA was used to rule out inflammation in 19% of patients.
Standard 50-degree fundus photography may not detect important abnormalities that may be more easily and accurately documented with UWFFA. The identification of these findings may impact clinical care, both when monitoring inflammation and ruling out posterior involvement. The presence of UWFFA leakage was highly associated with inflammatory activity. In the management of uveitis patients, wide field imaging of the retinal periphery may have added value over standard fundus photography.
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