Peripheral Vessel Leakage (PVL): A New Angiographic Finding in Diabetic Retinopathy Identified with Ultra Wide-Field Fluorescein Angiography

Abstract

Purpose: To characterize the relationship between peripheral vessel leakage and other angiographic features of diabetic retinopathy.

Design: Retrospective, consecutive case series.

Methods: Consecutive ultra wide-field angiographs obtained at a single institution for diabetic retinopathy were graded for angiographic characteristics including macular edema, retinal neovascularization, retinal vascular perfusion abnormalities, and retinal vascular staining and leakage.

Results: Angiographic characteristics of 264 eyes of 143 patients were evaluated. Findings included focal and diffuse angiographic macular edema (150/264, 57%), neovascularization (107/264, 41%), late peripheral vascular leakage (PVL) (107/264, 41%), and peripheral non-perfusion (142/264, 54%). Amongst all subjects untreated peripheral non-perfusion was associated with anterior neovascularization (78% vs. 48%, p = 0.0001, Fisher exact test) and posterior neovascularization (78% vs. 43%, p < 0.0001), but not with macular edema (p = 0.71). PVL was associated with peripheral non-perfusion (78% vs. 38%, p < 0.0001) and posterior neovascularization (53% vs. 35%, p = 0.01), but not with macular edema (p = 0.449). However, focal macular edema was strongly associated with PVL (33% vs. 13%, p = 0.008) in eyes without peripheral non-perfusion. Amongst untreated eyes with non-proliferative retinopathy and macular edema, there was a trend for association between macular edema and peripheral non-perfusion (p = 0.065).

Conclusion: Untreated peripheral non-perfusion and late peripheral vascular leakage detected using ultra wide-field FA are associated with neovascularization in diabetic retinopathy. PVL may be associated with focal diabetic macular leakage in this cohort.

KEYWORDS::

• diabetic retinopathy
• fluorescein angiography
• optos
• ultra wide-field angiography
• non-perfusion
• macular edema
• neovascularization
• angiographic leakage
• edema

ACKNOWLEDGMENTS

Material from this manuscript was presented at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Ft. Lauderdale, FL, on April 30, 2008, and at the 26^th Annual Meeting of the American Society of Retina Specialists, Maui, HI, on October 13, 2008.

Declaration of Interest: Supported by the Frederic G. Rappaport Fellowship Award, Jules Stein Eye Institute, UCLA to Scott C.N. Oliver, MD. The sponsor had no role in the design or conduct of this research. The authors have served on the speakers’ bureau and Dr. Schwartz has served as a consultant for Optos, plc, Dunfermline, UK.