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I. Kozak, D.-U. Bartsch, T. M. Clark, V. L. Morrison, I. Falkenstein, A. M. Tammewar, F. Mojana, B. Lee, W. R. Freeman; Understanding the Discrepancy Between Fluorescein Angiography and High-Resolution Optical Coherence Tomography in Detection of Macular Edema. Invest. Ophthalmol. Vis. Sci. 2007;48(13):114.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the abilities of high resolution optical coherence tomography (OCT) and fluorescein angiography (FA) to detect macular edema of various etiologies and explain possible discrepancies in findings between the two techniques.
A retrospective study reviewing imaging studies of eyes that underwent simultaneous conventional FA (HRA, Heidelberg, Germany)/StratusOCT (Zeiss, Dublin, CA, U.S.A.) examination over the 12 months period at one retina center. The eyes were imaged to rule out macular edema due to retinovascular diseases, exudative age-related macular degeneration (AMD) and uveitis. A subset of patients underwent examination with extremely high-resolution (6 microns)/ultrahigh speed Spectral OCT/scanning laser phthalmoscope (SLO) (OTI, Toronto, Canada).
Out of 1272 eyes (654 patients; 36 unilateral exams) the diagnosis of macular edema was confirmed in 1208 eyes (94.96%) by both techniques. There were 49 eyes (3.85%) in which FA showed dye leakage in the macular area and OCT showed normal foveal contour and normal thickness of adjacent retina. This discrepancy was observed most frequently in eyes with diabetic macular edema (n=25) and exudative AMD (n=14). A subset of eyes of this group that were imaged with extremely high-resolution/ultrahigh speed Spectral OCT/SLO showed subtle diffuse lucencies in the retina. In 15 eyes (1.17%) OCT showed intra/subretinal fluid, which was missed on FA. This occurred most commonly in eyes with exudative AMD (n=13).Conslusions: Both the FA and OCT are highly sensitive techniques and correlate well in detection of macular edema caused by various retinal and choroidal diseases. However, there a small chance that when performed alone they might miss existing subtle macular edema. The use of extremely high-resolution/ultrahigh speed Spectral OCT/SLO can detect subtle edema correlating with fluorescein leakage which does not accumulate in cysts and therefore helps to explain the cases where FA indicates edema and Stratus OCT does not.
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