Ultra-Wide Angle Fluorescein Angiographic Evaluation of the Retinal Periphery in the Management of Retinal Vascular Diseases

Abstract

Purpose:: The Optos Panoramic200A^TM Angiography System is a new technology that simultaneously scans 200° of the retina in 0.25 seconds producing high resolution panoramic images. Simultaneous capture of the wide angle image may provide a higher quality image than composite images of various temporal sequences. This system potentially enhances the ability to detect peripheral angiographic abnormalities in various retinal vascular conditions.To evaluate the utility of this system in the diagnosis and management of retinal vascular diseases. Specifically, we hypothesize that early detection and treatment of retinal vascular non-perfusion and subsequent proliferative vasculopathy may minimize the amount of retinal photocoagulation necessary to control disease.

Methods:: A retrospective analysis of more than 200 wide angle angiograms was carried out. Indications, diagnoses, management decisions and clinical outcomes were evaluated and compared to historical controls.

Results:: When given a choice of conventional posterior pole angiography versus ultra-wide field angiography 6 of 7 surgeons opted for ultra-wide angle angiography on a regular basis. Early diagnosis of peripheral retinal perfusion abnormalities was common, and on several occasions the working diagnosis changed based on peripheral angiographic findings. Angiographically guided photocoagulation was carried out on multiple occasions, often earlier in the course of diagnosis and management than would have typically occurred. In many cases this early treatment of proliferative vasculopathy was felt to have successfully treated the disease while minimizing the ablated areas, in some cases substantially preserving visual field. In 6 cases of diffuse diabetic macular edema, peripheral photocoagulation to ischemic areas seemed to contribute to diminution of macular edema; 3 eyes experienced visual improvement.

Conclusions:: Ultra-wide field angiography may be very useful in the diagnosis and management of retinal vascular diseases. This system allows for early detection of peripheral retinal perfusion abnormalities and further study may yield new strategies for early detection and treatment of retinal vascular disease.

Keywords: imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • retinal neovascularization • vascular occlusion/vascular occlusive disease