Ultra Wide-Field Angiographic Characteristics of Branch Retinal and Hemicentral Retinal Vein Occlusion Ophthalmology 2010;117 Ap. 양지욱/R4 김성일

Fluorescein angiography 15º Fluorescein angiography - Retina, choroid, optic disc - Angle 15, 30, 50º 30º 50º

망막 주변부 촬영이 힘들다 특히 산동이 잘 안되는 경우, 환자의 협조가 안되는 경우

Optos C200 MA scanning laser ophthalmoscope - Angle : 200º

introduction Retinal vein occlusion Angiography Most common retinal vascular occlusion Sequelae – neovascularization, macular edema Angiography Used to identify, monitor, treat sequelae Short coming Rack of visualization of peripheral retina 30 degree, 75 degree with composite images Optos C200 MA scanning laser ophthalmoscope Non-contact-lens visualize up to 200 degree

Aim of this study To study the peripheral angiographic feature of BRVO and HRVO Investigate peripheral retinal vascular pathology is associated with visually significant sequelae

methods Retrospective review Ultra wide-field fluorescein angiograms primary diagnosis of BRVO and HRVO Optos C200 MA (Optos, PLC) after iv 5 cc of sodium fluorescein Grading by a single, masked reviewer nonperfusion ( 1 ≥ disc area ) neovascularization ( focal leakage 2 ≥ disc diameters) macular edema (late hyperfluorescence ≥ 500 μm diameter) late peripheral vascular leakage (LPVL, late venous or arterial hyperfluorescence) prior evidence of panretinal photocoagulation * further graded as anterior/posterior to ”equator”

OCT images Statistic analysis to confirm macular thickening to detect VMT, serous macular detachment macular edema – evidence of angiographic macular edema and macular thickening on OCT without VMT Statistic analysis SAS 9.1 Chi-square test

results 76 angiograms 15 prior injections Prior laser Tx BRVO - 65 eyes(86%) HRVO - 11 eyes(14%) 15 prior injections anti-VEGF (10 eyes) IVTA ( 5 eyes) Prior laser Tx Grid macular laser(11 eyes) Peripheral scatter laser(20 eyes)

Neovascularization: 16 (21%) LPVL: 62(82%) Macular edema angiograpic : 61 eyes (80%) thickening on OCT : 56 eyes VMT : 2 eyes Nonperfusion : 62 eyes Neovascularization: 16 (21%) LPVL: 62(82%)

Untreated nonperfusion at any location was associated with neovascularization at any location (P = 0.033)

Untreated nonperfusion was associated with macular edema (P = 0.043) Anterior nonperfusion – macular edema (P = 0.007)

Late peripheral vessel leakage was not significantly associated with macular edema, nonperfusion, or neovascularization

discussion Value of peripheral fluorescein angiography delineation of retinal vascular nonperfusion in the far retinal periphery detection of subtle areas of early peripheral neovascularization NV Ant. nonperfusion Macular edema

LPVL is not easily appreciated unless wide-field angiographic study Late peripheral vessel leakage

Nonperfusion was associated with macular edema Nonperfusion was associated with neovascularization Support the hypothesis elevated level of VEGF, IL-6 correlate with macula edema zones of retinal nonperfusion may stimulate production of biochemical mediators leading to neovascularization the same areas of nonperfusion leading to neovascularization may also promote the development of macular edema

Explanation for nonperfusion without macular edema (20%) duration of vein occlusion total area of nonperfusion systemic factors (uncontrolled hypertension, diabetes, hyperlipidemia)

Limitation of the study Retrospective review with selection bias Inhomogeneous group with various stages of disease and treatment randomized, prospective studies are needed to confirm the findings Further studies are needed to determine the role of treatment of peripheral nonperfusion in the management and prevention of NV and ME