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Rym Maamouri; Peripheral Lesions in Non Proliferative Diabetic Eetinopathy Using Wide Field Angiography. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6339. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate peripheral lesions and the combined diabetic macular edema in non proliferative diabetic retinopathy (NPDR) using a wide field fluorescein angiography.
In a retrospective study, consecutive wide-field angiographs obtained using the Heidelberg Retina Angiograph 2 with a contact lens system Staurenghi were graded in: areas of non perfused retina, retinal neovascularization and retinal vascular leakage seen on an overly of conventional 7 standard fields. In all patients macular edema was detected on both angiography and Spectral-domain optical coherence tomography using Topcon 2000.
A total of 71 eyes in 39 diabetic patients were included. Distribution of NPDR severity was: mild NPDR in 6% of eyes, moderate NPDR in 21% and severe NPDR in 73%. Lesions predominated in the mid periphery in 78% and were present in 21% in the extreme periphery. Findings included angiographic peripheral non perfusion in 87% of eyes predominantly in supero-temporal in 71%), neovascularization in 14%, peripheral vessel leakage in 85%, macular edema in 53% and macular ischemia in 4%. A thicker retina was observed in eyes with peripheral non perfusion (353µm vs. 254µm p=0,006). Retinal non perfusion was associated with macular edema (97% vs. 76%, p=0,01) and poor visual acuity (p<0,001). Peripheral vessel leakage was associated with peripheral non-perfusion (p<0.001) but not with retinal neovascularization (53% vs. 35%, p=0.01), neither with macular edema (p=0.449).
Using the wide field imaging was useful to detect areas of retinal non perfusion in 87% of NPDR, to improve the classification and to indicate treatment in 28/71 eyes with NPDR. It highlighted that eyes with NPDR and a larger areas of retinal non perfusion had more macular edema. This may make us reconsider the treatment and the management of diabetic macular edema using either a targeted laser treatment in the area of retinal non perfusion or anti-VEGF intravitreal injection.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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