Ultra-wide-field fluorescein angiography in diabetic retinopathy: a narrative review

Figures & data

Figure 1 Ultra-wide-field fluorescein angiography (UWFA) of a 68-year-old male patient affected by proliferative diabetic retinopathy in both the eyes. Early phases of the right (A) and left (B) eyes. Late phases of the right (C) and left (D) eyes. In early angiographic phases, UWFA discloses hyperfluorescent dots in both the eyes suggestive of microaneurysms and broad peripheral and mid peripheral areas of capillary non-perfusion. In late frames, UWFA discloses peripheral perivascular and mild macular dye leakage, suggestive of blood–retina barrier disruption, and intense hyperfluorescence of retinal surface, indicative of epiretinal neovascularization in both the eyes.

Table 1 Synoptic table on current literature regarding ultra-wide-field fluorescein angiography in diabetic retinopathy

Study	Year	Study type	Number of patients (eyes)	Major findings
Friberg et al^Citation10	2008	Prospective	30 (30)	UWFA allows the visualization of wider retinal surface and more retinal ischemia compared to conventional systems, but with reduction in image quality
Oliver and Schwartz^Citation13	2010	Retrospective case series	143 (264)	Peripheral nonperfusion at UWFA is associated with NV and macular ischemia, while PVL is associated with peripheral nonperfusion and NV. DME is not associated with neither peripheral nonperfusion nor PVL
Wessel et al^Citation2	2012	Retrospective case series	118 (218)	Compared to 7SF, UWFA shows more total retinal surface, capillary nonperfusion, NV, and PRP. UWFA revealed retinal pathology in 10% of the eye judged normal with 7SF
Muqit et al^Citation21	2013	Prospective randomized pilot study	30 (30)	SI-PRP, MT-PRP, and TRP are equally effective in inducing PDR regression. TRP and SI-PRP produce higher CMT reduction than PRP. No change in VA, RNFL thickness, or laser-induced complications were observed in these cohort
Muqit et al^Citation20	2013	Prospective nonrandomized study	20 (28)	Optos-guided TRP is a safe procedure which allows PDR regression. Additional PRP was required in 30% of the eyes at 12 weeks. TRP does not affect CMT, MD on VFs and VA.
Reddy et al^Citation19	2009	Case series	2 (2)	Optos-guided TRP allows PDR regression avoiding complications of standard PRP (ie, VF loss, DME, reduction in VA)
Kim et al^Citation18	2014	Retrospective case–control study	46 (46)	PVL, NV, and peripheral nonperfusion assessed with UWFA are greater in PVDVH group than NPVDVH one. Such differences are not seen with 7SF
Wessel et al^Citation15	2012	Retrospective case series	70 (122)	DME is correlated with capillary nonperfusion quantified at UWFA. Peripheral ischemia is an independent risk factor for DME
Silva et al^Citation27	2015	Retrospective cross-sectional study	27 (68)	Peripheral ischemia quantified at UWFA correlates with DR severity and PPLs
Patel et al^Citation16	2013	Retrospective case series	76 (148)	Recalcitrant DME was found mostly in eyes with larger areas of retinal nonperfusion and greater DR severity
Sim et al^Citation17	2014	Retrospective case series	47 (47)	Peripheral ischemia quantified at UWFA correlates with FAZ area. PVL and FAZ area correlates only in laser naïve eyes. Peripheral ischemia and PVL were not associated with VA, conversely VA was associated with CMT and FAZ area
Kim et al^Citation26	2015	Retrospective case series	79 (103)	Differences between ISI corrected for image distortion created by UWFA and uncorrected ISI increase with peripheral ischemia

Abbreviations: UWFA, ultra-wide-field fluorescein angiography; NV, neovascularization; DME, diabetic macular edema; PVL, peripheral vessel leakage; PRP, panretinal photocoagulation; 7SF, seven standard fields; PDR, proliferative diabetic retinopathy; SI-PRP, standard intensity-PRP; MT-PRP, minimally traumatic-PRP; TRP, targeted retinal photocoagulation; CMT, central macular thickness; MD, mean defect; VF, visual field; VA, visual acuity; RNFL, retinal nerve fiber layer; ISI, ischemic index; PVDVH, recurrent postvitrectomy diabetic vitreous hemorrhage; NPVDVH, non-PVDVH; PPL, predominant peripheral lesion; FAZ, foveal avascular zone.

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