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Seenu M. Hariprasad, Ravi D. Patel; Fluorescein Angiographic Features of Recalcitrant Diabetic Macular Edema Using Optos Wide-Field Imaging. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2675.
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To examine Fluorescein Angiographic Features of Recalcitrant Diabetic Macular Edema using Optos Wide-Field Imaging. In this study we have 2 main objectives: i) to study the peripheral angiographic features of patients with recalcitrant diabetic macular edema (DME) and peripheral retinal nonperfusion in non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) and ii) to demonstrate the diagnostic value of wide-field fluorescein angiography (WFFA) in elucidating the role of subtle peripheral pathology in diabetic retinopathy.
This is a retrospective observational case series of approximately 30 eyes of 60 patients who have been diagnosed with DME for at least 2 years at a single academic institution. Protocols were approved by the institutional review board at the study site, and consent was obtained from each patient. A retrospective review of all Optos WFFA and spectral domain OCT (SD-OCT) was performed at baseline (1 clinic visit). Three study cohorts were enrolled. Cohort 1 (control) subjects were diagnosed with NPDR without DME. Cohort 2 subjects were diagnosed with NPDR and recalcitrant DME. Cohort 3 subjects diagnosed with PDR and recalcitrant DME with or without previous pan retinal photocoagulation (PRP).
Our preliminary data demonstrates an increased incidence of peripheral nonperfusion on Optos wide-field fluorescein angiography with recalcitrant DME (on SD-OCT) in all non-control cohorts. Further statistical analysis is to follow. Also, the diagnostic value of the WFFA was demonstrated by detecting subtle peripheral neovascularization that was not found on clinical exam.
WFFA is an excellent diagnostic instrument that provides a reproducible method to detect subtle peripheral neovascularization in diabetic retinopathy. Areas of untreated retinal nonperfusion may generate biochemical mediators that promote ischemia and recalcitrant DME. Targeted retinal photocoagulation to ischemic retina will likely show improvement of recalcitrant DME.
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