The application of ultra-wide field fluorescein angiography in the evaluation of peripheral vascular changes following retinal vein occlusion

Objective

To investigate the peripheral vascular findings in eyes with branch retinal vein occlusion (BRVO) and hemi-retinal vein occlusion (HRVO) using ultra-wide field fluorescein angiography (UWFFA), and analyze the influence of relative systemic factors on retinal vascular leakage.

Methods

A retrospective case-control study was designed.The 153 eyes of 146 patients with BRVO and 40 eyes of 40 patients with HRVO were include in Tianjin Medical University Eye Institute from September 2017 to March 2018.UWFFA was carried out in the patients, and the images were analyzed by Vantage Review software.The eyes were divided into two groups based on the whether the leakage occurred in other quadrant or fellow eye.The eyes with the fluorescence leakage only in the quadrant of affected vessel in late stage of UWFFA were in the RVO1 group, and the eyes with the fluorescence leakage in other quadrants or fellow eye besides affected vessel were in the RVO2 group.Relative past medical histories were recorded, such as hypertension, high cholesterol and diabetes mellitus.The influence of medical histories on vascular leakage in RVO1 group and RVO2 group with different histories was analyzed, respectively, and systemic factors which affected leakage degree were evaluated.

Results

In 179 eyes with RVO, fluorescence leakage occurred in late stage of UWFFA besides affected vessel in 25 eyes (14.0%), including 19 eyes in the affected eyes (10.6%) and 6 eyes in fellow eyes (3.4%). Hypertension, high cholesterol and diabetes mellitus were found in 77, 28 and 21 patients, respectively.In 77 hypertension patients, 66 were in the RVO1 group, and 9 were in the RVO2 group (11.69%), and in 102 non-hypertension patients, 86 were in the RVO1 group, and 16 were in the RVO2 group (15.69%), without significant difference was seen in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between hypertension and non-hypertension patients (χ²=0.298, P=0.585). In 28 high cholesterol patients, 24 were in the RVO1 group, and 4 were in the RVO2 group (14.29%), and in the 151 patients without high cholesterol, 130 were in the RVO1 group, and 21 were in the RVO2 group (13.91%), without significant difference in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between high cholesterol and non-high cholesterol (χ²=0.000, P=1.000). In 21 diabetes mellitus patients, 17 patients were in the RVO1 group, and 4 patients were in the RVO2 group (19.05%), and in 158 patients without diabetes mellitus, 137 were in the RVO1 group, and 21 were in the RVO2 group (13.29%), without significant difference was seen in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between diabetes mellitus and non- diabetes mellitus (χ²=0.144, P=0.704).

Conclusions

Unexpected late peripheral retinal leakage can be seen on the UWFFA in the eyes with BRVO and HRVO.Hypertension, high cholesterol and diabetes mellitus are not the main cause of these findings.UWFFA can disclose more peripheral, wider retinal lesions.

Retinal vein occlusion; Fluorescein angiography; Ultra-wide-field images; Fluorescein leakage; Periphery retinal vessels; Hypertension; High cholesterol; Diabetes mellitus