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M. M. Wessel, G. D. Aaker, G. Parlitsis, M. Cho, D. J. D'Amico, S. Kiss; Ultra-Widefield Angiography Significantly Improves the Detection and Classification of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4689.
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To assess the utility of ultra-widefield angiography in the evaluation of patients with diabetic retinopathy (DR) and to compare the visualized retinal pathology to that seen on seven-standard field imaging. (Figure)
A retrospective review of fluorescein angiograms in patients with diabetes who underwent diagnostic fluorescein angiography using the Optos Optomap Panoramic 200A imaging system for evaluation of DR. The visualized area of the retina, retinal ischemia and retinal neovascularization were quantified by two independent graders using Adobe software. The respective areas identified on the ultra-widefield imaging were compared to a modified seven-standard field image as outlined in the Early Treatment of Diabetic Retinopathy Study.
Eleven eyes with non-proliferative diabetic retinopathy (NPDR) and 9 with proliferative diabetic retinopathy (PDR) were included. On average, 2.6 times more area of retina was visualized with ultra-widefield imaging compared to seven standard fields (see figure).In the NPDR group, ultra-widefield imaging demonstrated 3.6 times more area of ischemia compared to seven-standard fields (p=0.006). Ultra-widefield imaging was able to demonstrate peripheral ischemia not visible in seven-standard fields in 2 eyes. In the PDR group, ultra-widefield imaging demonstrated 4.2 times more area of ischemia and 2.6 times more area of neovascularization compared to seven-standard fields (p=0.001 and p=0.13 respectively). Ultra-widefield imaging was able to demonstrate peripheral neovascularization not visible on seven-standard fields in one eye.
Ultra-wide field angiography significantly improves the visualization of retinal pathology, including ischemia and neovascularization, in patients with DR. This improved visualization can alter the classification of DR and may influence the follow-up and treatment of these patients.
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