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L. Y. Ho, T. R. Friberg; Quantification of Peripheral Retinal Ischemia in Patients With Diabetic Macular Edema Using Optomap® fa Dynamic Ultra-Widefield Angiography. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3495.
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Examination of the retinal periphery may offer information to help diagnose and monitor eye conditions and assist in treatment determinations. The Optomap® fa provides high resolution angiographic information in an ultra-widefield and can be used to quantify theamount of peripheral retinal ischemia in patients with diabetic macular edema.
A retrospective image assessment was performed in 14 diabetic eyes (7 consecutive patients) with clinically significant macular edema imaged with the Optomap® fa Dynamic Ultra-widefield Angiography device between October 1, 2007 and November 30, 2007. A determination of the total area of the retina imaged and the total area of capillary dropout (ischemia) was conducted on each arteriovenous image by counting individual pixels. The percent of the retina that was perfused was then calculated.
The average age of our patient population was 55.6 years with a female to male ratio of 4:3. Six eyes had evidence of early proliferative diabetic retinopathy and eight eyes had nonproliferative diabetic changes. Of the fourteen eyes included in the study, the observed percentage of the retina perfused ranged between 29.0% and 98.9% with a mean retinal perfusion in this sample of 74.7%. In other words, approximately 1/4 of the retina was deemed ischemic in our typical patient with diabetic retinopathy and macular edema.
Macular edema in diabetic eyes is often accompanied by retinal ischemia. The latter likely exacerbates or causes macular edema by expressing VEGF. Strategies used to treat macular edema which also address the peripheral ischemic component are likely to be more durable. For instance, such a strategy might incorporate the use of an anti-VEGF agent coupled with laser ablation of the ischemic regions in addition to focal photocoagulation.
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