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Valentina Franco-Cardenas, Irena Tsui, Gad Heilweil, Steven D. Schwartz; Ultra Wide Field Fluorescein Angiography Accurately Evaluates Macular Pathology In Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1720.
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High resolution fluorescein angiography correlates well with spectral domain optical coherence tomography (SD-OCT) when assessing macular pathology in patients with diabetic retinopathy (DR). Ultra wide field fluorescein angiography (UWFFA) has proven useful for detecting peripheral pathology. Validation for macular pathology in DR with UWFFA is to date uncertain
A retrospective imaging review, which included all patients diagnosed with DR who underwent UWFFA and SD-OCT on the same day, was performed. UWFFA was graded for presence of macular leakage (petalloid or diffuse pattern) and ischemic abnormalities of the foveal avascular zone (FAZ). SD-OCT was evaluated by a different reviewer for signs of diabetic macular edema (cystoid or diffuse type), foveal thickness, average macular thickness, ganglion cell layer (GCL) atrophy and evidence of epiretinal traction (ERM).
Inclusion criteria were met by 216 eyes. Angiographic leakage on UWFFA was present in 132 eyes (61%) and 112 eyes (52%) had macular edema on SD-OCT (p<0.0001) with a kappa agreement (K) K=0.59. Petalloid angiographic leakage on UWFFA correlated with cystoid macular edema on SD-OCT (p<0.0001) (K=0.61). Diffuse angiographic leakage correlated with diffuse macular edema (p<0.0001) (K=0.46). The sensitivity of UWFFA for detection of any type of macular leakage was 89.3%, with a specificity of 69.2%. GCL atrophy was present in 34 eyes of which 24 eyes (71%) presented with an abnormal FAZ on UWFFA (p<0.0001) (K=0.77). ERM was detected in 55 eyes (25%) and its presence correlated well with any type of leakage in UWFFA, mostly within the diffuse leakage group (p< 0.0001). Any type of leakage detected in UWFFA had an increased foveal thickness (360.6±123µ vs 273±53 µ) and macular thickness average (367±75µ vs 306±33µ) in SD-OCT when compared against the non leaking group (p<0.0001).
The presence of macular pathology in this cohort of patients was high, allowing us to study the utility of UWFFA in diabetic maculopathy. UWFFA provided accurate angiographic macular assessment which closely correlated with SD-OCT findings. UWFFA seems to provide clinically useful angiographic macular data.
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