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

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

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

4. Optos C200 MA scanning laser ophthalmoscope
- Angle : 200º

5. 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

6. 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

7. 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”

8. 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

9. 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)

10. 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%)

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

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

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

14. 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

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

16. 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

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

18. 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