Application of ultra-wide-angle fluorescein angiography in diabetic macular edema and retinal ischemia_Chinese Journal of Ocular Fundus Diseases

Authors：

Hao Linna , Ren Xiuyu , Chen Dongyang ,  Zhang Yanchun , Li fengzhi , Kang Ziwei

Xi'an People’s Hospital (Xi'an Fourth Hospital), Diabetic Retinopathy Center of Shaanxi Eye Hospital, Xi'an Ocular Fundus Disease Research Institute, Xi'an 710004, China;

Corresponding?author：

Zhang Yanchun, Email: zhangyanchun1239@126.com

Keywords：

Diabetic retinopathy; Macular edema; Fluorescein angiography

DOI：

10.3760/cma.j.cn511434-20200324-00129

Video：

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Objective To observe the application of ultra wide angle FFA (UWFA) in the study of the correlation between diabetic macular edema (DME) and retinal ischemia.Methods One hundred and forty-five patients (220 eyes) with diabetic retinopathy (DR) diagnosed by fundus and FFA in Shaanxi Eye Hospital from January to August in 2018 were enrolled in the study. There were 132 eyes from 85 males and 88 eyes from 60 females. The average age was 54.87±10.89 years old, 171 eyes were non proliferative DR (mild 27 eyes, moderate 32 eyes, severe 112 eyes), 49 eyes were proliferative DR. There were 141 eyes with retinal ischemia. None of them received retinal laser photocoagulation, intravitreal injection of drugs and other eye surgery. UK Optomap200Tx imaging system was used for UWFA examination. According to whether the central macular retina of 2 disc diameter area was involved, the eyes were divided into DME group (183 eyes) and non DME group (37 eyes). According to different appearance of fluorescein leakage in macular zone, DME group was further divided into focal leakage (FL) group, diffuse leakage (DL) group and diffuse cystic leakage (DCL) group, with 94, 73 and 16 eyes, respectively. The incidence of retinal ischemia, retinal neovascularization (RNV) and/or NVD were compared between DME group and non DME group, and the difference of retinal ischemia index (IIS) of three macular edema subgroups was further compared. The differences of retinal ischemia, RNV and/or NVD between DME group and non DME group were compared by chi square test or Fisher exact probability method. The different retinal IIS of three macular edema subgroups was compared by one-way ANOVA.Results Among 183 eyes in DME group, 132 eyes (72.13%, 132/183) were accompanied with retinal ischemia, and 9 eyes (24.32%, 9/37) were accompanied with retinal ischemia in non DME group. There was significant difference in the incidence of retinal ischemia between the two groups (χ²= 30.56, P＜0.05). In FL group, DL group and DCL group, there were 51 (54.26%, 51/94), 70 (95.89%, 70/73) and 11 (68.75%, 11/16) eyes with retinal ischemia, and 11 (11.70%, 11/94), 30 (41.10%, 30/73) and 4 (25.00%, 4/16) eyes with NVD and/or RNV, respectively, The retinal ischemia indexes of these three groups were 0.0516±0.0961, 0.2192±0.2166, 0.1244±0.1460. There were statistically significant differences in the incidences of retinal ischemia (χ²=35.53), NVD and/or RNV (χ²=18.50) and retinal ischemia indexes (F=22.80) among the three groups (P=0.000 0, ＜0.050 0, ＜ 0.000 1).Conclusions UWFA can dynamically evaluate the retinal ischemia in DME patients, and the enlargement of ischemic area. The formation of RNV are more likely to form DL macular edema.

Citation： Hao Linna, Ren Xiuyu, Chen Dongyang, Zhang Yanchun, Li fengzhi, Kang Ziwei. Application of ultra-wide-angle fluorescein angiography in diabetic macular edema and retinal ischemia. Chinese Journal of Ocular Fundus Diseases, 2020, 36(12): 954-958. doi: 10.3760/cma.j.cn511434-20200324-00129 Copy

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6.	Chatziralli I, Dimitriou E, Theodossiadis G, et al. Intravitreal ranibizumab alone or in combination with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy with coexistent macular edema: long-term outcomes of a prospective study[J]. Acta Diabetol, 2020, 57(10): 1219-1225. DOI: 10.1007/s00592-020-01548-y.
7.	Bandello F, Battaglia Parodi M, Lanzetta P. Diabetic macular edema[J]. Dev Ophthalmol, 2017, 58: 102-138. DOI: 10.1159/000455277.
8.	Silva PS, Cavallerano JD, Sun JK, et al. Nonmydriatic ultrawide field retinal imaging compared with dilated standard 7-field 35-mm photography and retinal specialist examination for evaluation of diabetic retinopathy[J]. Am J Ophthalmol, 2012, 154(3): 549-559. DOI: 10.1016/j.ajo.2012.03.019.
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10.	中華醫學會眼科學會眼底病學組. 我國糖尿病視網膜病變臨床診療指南(2014年)[J]. 中華眼科雜志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
11.	Wessel MM, Nair N, Aaker GD, et al. Peripheral retinal ischaemia, as evaluated by ultra-widefield fluorescein angiography, is associated with diabetic macular edema[J]. Br J Ophthalmol, 2012, 96(5): 694-698. DOI: 10.1136/bjophthalmol-2011-300774.
12.	Murphy RP, Ferris III FL, ETDRS Research Group. Photocoagulation for diabetic mMacular EDEMA: results of the Early Treatment Diabetic Retinopathy Study[J]. Ocular Circulation and Neovascularization, 1987, 50:99-109. DOI: 10.1007/978-94-009-3337-8_15.
13.	Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema[J]. Am J Ophthalmol, 2004, 137(2): 313-322. DOI: 10.1016/j.ajo.2003.09.016.
14.	Acan D, Karahan E, Kocak N, et al. Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema[J]. Int J Ophthalmol, 2018, 11(7): 1204-1209. DOI: 10.18240/ijo.2018.07.21.
15.	陳長征, 王曉玲. 正確分析周邊部視網膜超廣角熒光素眼底血管造影特征[J]. 中華實驗眼科雜志, 2020, 38(7): 562-565. DOI: 10.3760/cma.j.cn115989-20190401-00158.Chen CZ, Wang XL. To correctly analyze ultra-wide field fluorescein angiography in peripheral retina[J]. Chin J Exp Ophthalmol, 2020, 38(7): 562-565. DOI: 10.3760/cma.j.cn115989-20190401-00158.
16.	陳長征, 許阿敏. 提升超廣角熒光素眼底血管造影技術應用水平, 深化周邊眼底特征觀察及臨床意義研究[J]. 中華眼底病雜志, 2017, 33(1): 7-9. DOI: 10.3760/cma.j.issn.1005-1015.2017.01.003.Chen CZ, Xu AM. Improve our understanding of ocular fundus diseases with ultra-wide-field fluorescein angiography[J]. Chin J Ocul Fundus Dis, 2017, 33(1): 7-9. DOI: 10.3760/cma.j.issn.1005-1015.2017.01.003.
17.	張美霞, 楊蘭芬, 羅成仁, 等. 糖尿病視網膜病變黃斑水腫的臨床分析[J]. 中華眼底病雜志, 2003, 19(2): 83-86. DOI: 10.3760/j.issn:1005-1015.2003.02.004.Zhang MX, Yang LF, Luo CR, et al. Clinical analysis of the results of macular edema in diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2003, 19(2): 83-86. DOI: 10.3760/j.issn:1005-1015.2003.02.004.
18.	Oliver SCN, Schwartz SD. Ultra-widefield fluorescein angiography[M]//Oliver SCN, Schwartz SD. Retinal Angiography and Optical Coherence Tomography. Berlin: Springer Publishing Company, 2009:407-417.

1. Vujosevic S, Berton M, Bini S, et al. Hyperreflective retinal spots and visual functino after anti-vascular endothelial growth factor treatment in center-involving diabetic macular edema[J]. Retina, 2016, 36(7): 1298-1308. DOI: 10.1097/IAE.0000000000000912.
2. Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic macular edema by the European society of retina specialists (EURETINA)[J]. Ophthalmologica, 2017, 237(4): 185-222. DOI: 10.1159/000458539.
3. Meyer CH. Current treatment approaches in diabetic macular edema[J]. Ophthalmologica, 2007, 221(2):181-131. DOI: 10.1159/000098257.
4. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1.[J]. Arch Ophthalmol, 1985, 103(12): 1796-1806. DOI: 10.1001/archopht.1985.01050120030015.
5. Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic retinopathy preferred practice pattern?[J]. Ophthalmology, 2020, 127(1): 66-145. DOI: 10.1016/j.ophtha.2019.09.025.
6. Chatziralli I, Dimitriou E, Theodossiadis G, et al. Intravitreal ranibizumab alone or in combination with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy with coexistent macular edema: long-term outcomes of a prospective study[J]. Acta Diabetol, 2020, 57(10): 1219-1225. DOI: 10.1007/s00592-020-01548-y.
7. Bandello F, Battaglia Parodi M, Lanzetta P. Diabetic macular edema[J]. Dev Ophthalmol, 2017, 58: 102-138. DOI: 10.1159/000455277.
8. Silva PS, Cavallerano JD, Sun JK, et al. Nonmydriatic ultrawide field retinal imaging compared with dilated standard 7-field 35-mm photography and retinal specialist examination for evaluation of diabetic retinopathy[J]. Am J Ophthalmol, 2012, 154(3): 549-559. DOI: 10.1016/j.ajo.2012.03.019.
9. Sun JK, Aiello LP. The future of ultrawide field imaging for diabetic retinopathy: pondering the retinal periphery[J]. JAMA Ophthalmol, 2016, 134(3): 247-248. DOI: 10.1001/jamaophthalmol.2015.5384.
10. 中華醫學會眼科學會眼底病學組. 我國糖尿病視網膜病變臨床診療指南(2014年)[J]. 中華眼科雜志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
11. Wessel MM, Nair N, Aaker GD, et al. Peripheral retinal ischaemia, as evaluated by ultra-widefield fluorescein angiography, is associated with diabetic macular edema[J]. Br J Ophthalmol, 2012, 96(5): 694-698. DOI: 10.1136/bjophthalmol-2011-300774.
12. Murphy RP, Ferris III FL, ETDRS Research Group. Photocoagulation for diabetic mMacular EDEMA: results of the Early Treatment Diabetic Retinopathy Study[J]. Ocular Circulation and Neovascularization, 1987, 50:99-109. DOI: 10.1007/978-94-009-3337-8_15.
13. Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema[J]. Am J Ophthalmol, 2004, 137(2): 313-322. DOI: 10.1016/j.ajo.2003.09.016.
14. Acan D, Karahan E, Kocak N, et al. Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema[J]. Int J Ophthalmol, 2018, 11(7): 1204-1209. DOI: 10.18240/ijo.2018.07.21.
15. 陳長征, 王曉玲. 正確分析周邊部視網膜超廣角熒光素眼底血管造影特征[J]. 中華實驗眼科雜志, 2020, 38(7): 562-565. DOI: 10.3760/cma.j.cn115989-20190401-00158.Chen CZ, Wang XL. To correctly analyze ultra-wide field fluorescein angiography in peripheral retina[J]. Chin J Exp Ophthalmol, 2020, 38(7): 562-565. DOI: 10.3760/cma.j.cn115989-20190401-00158.
16. 陳長征, 許阿敏. 提升超廣角熒光素眼底血管造影技術應用水平, 深化周邊眼底特征觀察及臨床意義研究[J]. 中華眼底病雜志, 2017, 33(1): 7-9. DOI: 10.3760/cma.j.issn.1005-1015.2017.01.003.Chen CZ, Xu AM. Improve our understanding of ocular fundus diseases with ultra-wide-field fluorescein angiography[J]. Chin J Ocul Fundus Dis, 2017, 33(1): 7-9. DOI: 10.3760/cma.j.issn.1005-1015.2017.01.003.
17. 張美霞, 楊蘭芬, 羅成仁, 等. 糖尿病視網膜病變黃斑水腫的臨床分析[J]. 中華眼底病雜志, 2003, 19(2): 83-86. DOI: 10.3760/j.issn:1005-1015.2003.02.004.Zhang MX, Yang LF, Luo CR, et al. Clinical analysis of the results of macular edema in diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2003, 19(2): 83-86. DOI: 10.3760/j.issn:1005-1015.2003.02.004.
18. Oliver SCN, Schwartz SD. Ultra-widefield fluorescein angiography[M]//Oliver SCN, Schwartz SD. Retinal Angiography and Optical Coherence Tomography. Berlin: Springer Publishing Company, 2009:407-417.

Chinese Journal of Ocular Fundus Diseases

Application of ultra-wide-angle fluorescein angiography in diabetic macular edema and retinal ischemia

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