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Henry A. Leder, John P. Campbell, Yasir J. Sepah, Theresa Gan, Brian Cho, Elham Hatef Naimi, Mohamed A. Ibrahim, Roomasa Channa, Diana V. Do, Quan D. Nguyen; Wide-field Fundus Photography and Fluorescein Angiography in the Diagnosis and Management of Retinal Vasculitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4401.
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To determine the utility of wide-field imaging and wide-field fluorescein angiography system in the diagnosis and management of non-infectious retinal vasculitis.
In this prospective, comparative study of patients with non-infectious retinal vasculitis, at baseline, and at scheduled follow-up visits, patients underwent wide-field pseudo-color imaging and angiography performed with Optos P200TM System. Participating investigators were asked to determine disease activity and management changes based on exam alone, wide-field pseudo-color images, and wide-field angiography. Management decisions at each time point were compared to determine the influence of wide-field imaging on the clinician’s decisions for diagnosis and treatment. Disease activity, retinal non-perfusion, and changes over time were separately evaluated.
22 patients have been enrolled with a diagnosis of retinal vasculitis. Diagnoses included: idiopathic (7); panuveitis (6); Wegener (1); Behcet (3); Sarcoid (3); Intermediate uveitis (1); and optic neuritis (1) associated retinal vasculitis. 8 patients had evidence of active vasculitis on clinical exam alone, while 12 had evidence of active vasculitis on wide field fluorescein angiography but not on clinical exam. 1 patient had peripheral non-perfusion requiring scatter laser directed by the angiogram. Subsequent visits demonstrated improvement in 3 of 4 patients and stability in 1 patient.
In this prospective study, wide-field imaging and angiography assisted in the diagnosis and management of retinal vasculitis compared to standard of care imaging and clinical examination. Some patients had active disease only in the far peripheral retina, where standard fluorescein angiography (30, 50, or 60 degrees) was not able to transit and image this area. The additional information provided by wide field imaging may allow earlier detection of active vasculitis which may lead to earlier treatment and better patient outcomes. Additional studies are indicated to support our initial findings.
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