Tunis Med. 2021;99(7):757-763.
To assess the contribution of ultra-wide field (UWF) fluorescein angiography (FA) in clinically non proliferative diabetic retinopathy (DR) and to study the relationship between peripheral vascular lesions and the presence of diabetic macular edema (DME).
Retrospective study of consecutive UWF-FA obtained using a wide-field contact lens system. DME was detected on both FA and spectral-domain optical coherence tomography (SD-OCT).
A total of 71 eyes of 39 diabetic patients with clinically non proliferative DR (NPDR) was included. DR was clinically graded as severe NPDR in 52 eyes (73%), moderate NPDR in 15 eyes (21%) and mild NPDR in 4 eyes (6%). On UWF-FA, DR was predominantly anterior in 14% of cases (10/71), predominantly posterior in 48% of cases (34/71) and diffuse in 38% of cases (27/71). Retinal non perfusion was present in 87% of eyes (62/71), predominating in superior-temporal areas. Peripheral vessel leakage was present in 85% of cases (60/71) and retinal neovascularization was noted in 14% of cases (10/71), unpgrading DR severity from NPDR to proliferative DR in 10 eyes. DME was present on SD-OCT in 53% of cases. Central macular thickness was significantly higher in eyes with retinal non-perfusion (353 μm vs. 254 μm, p=0,006) and 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 retinal non-perfusion (p<0.001) and retinal neovascularization (53% vs. 35%, p=0.01), but it was not associated with the presence of DME (p=0.449).
UWF-FA was of great help assessing DR and evaluating peripheral retinal lesions in order to refine DR staging and to guide laser treatment. Besides, it allows better understanding of DME pathophysiology.
评估超广角（UWF）荧光素血管造影（FA）在临床非增生性糖尿病视网膜病变（DR）中的作用，并研究周边血管病变与糖尿病性黄斑水肿（DME）之间的关系。
回顾性研究使用广角接触镜系统获得的连续超广角 FA。DME 在 FA 和谱域光学相干断层扫描（SD-OCT）上均有发现。
共纳入 39 例临床非增生性 DR（NPDR）糖尿病患者的 71 只眼。DR 在临床上被分为 52 只眼（73%）为重度 NPDR，15 只眼（21%）为中度 NPDR，4 只眼（6%）为轻度 NPDR。在超广角 FA 上，DR 以前部为主者占 14%（10/71），以后部为主者占 48%（34/71），弥漫性者占 38%（27/71）。87%的眼（62/71）存在视网膜无灌注，主要位于上颞区。85%的眼（60/71）存在周边血管渗漏，14%的眼（10/71）出现视网膜新生血管，10 只眼从 NPDR 升级为增生性 DR。SD-OCT 上发现 53%的眼存在黄斑水肿。视网膜无灌注的眼中央黄斑厚度明显较高（353μm 比 254μm，p=0.006），视网膜无灌注与黄斑水肿（97%比 76%，p=0.01）和视力下降（p<0.001）相关。周边血管渗漏与视网膜无灌注（p<0.001）和视网膜新生血管（53%比 35%，p=0.01）相关，但与黄斑水肿无关（p=0.449）。
超广角 FA 有助于评估 DR 和评估周边视网膜病变，以便细化 DR 分期并指导激光治疗。此外，它还可以更好地了解 DME 的病理生理学。
