Abstract
Purpose: :
Experience using wide field fluorescein angiography with RetCamII in early detection and follow up of retinal pathology in infants.
Methods: :
The RetCam II (Clarity MS, Pleasanton, CA) was used to perform intravenous fluorescein angiography in 16 eyes of 8 children diagnosed as having retinal vascular pathology on clinical examination. Patients were referred from neonatal care units in Mexico City, and the procedure was performed on an outpatient basis under topical anesthesia. The procedure was monitored by a neonatologist and performed by a retina specialist trained to perform angiography with the RetCam.
Results: :
Sixteen eyes of 8 patients were evaluated. Fluorescein angiography enabled visualization of the retinal vasculature and helped identify retinal vascular pathologic changes. One patient was referred with intraretinal hemorrhages and vascular tortuosity to rule out CRVO, one patient was referred to evaluate a suspicious retinal lesion thought to be active retinocoroiditis and six patients were referred to evaluate ROP. In the patient with retinal hemorrhages, CRVO was promptly ruled out and follow up showed remission of the hemorrhages and a diagnosis of birth trauma related hemorrhages was established. In the patient with the suspect infectious lesion, active retinochoroditis was ruled out due to lack of hyperfluorescence of the lesion. In patients with ROP, staging and treatment of the disease was successfully performed. Early neovascularization in zone 1 or 2, and previously missed areas of active retinopathy of prematurity in the peripheral retina could be detected which improved the outcome. There were no side effects related to sodium fluorescein or the procedure, and it was well tolerated under topical anesthesia. In patients with active ROP requiring treatment, intravitreal injection of anti-VEGF agents was safely performed under topical anesthesia as well and follow up angiography could be performed in the same manner.
Conclusions: :
Wide field fluorescein angiography with RetCam aids in the early diagnosis and prompt management of retinal vascular pathology. It can be performed under topical anesthesia in a fast, safe and reproducible manner.
Keywords: imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • retinopathy of prematurity • retina