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Ultra-Widefield Fluorescein Angiographic Patterns, Retinal Microvascular Anomalies and Retinal Ischemic Index in Branch Retinal Vein Occlusions with Established Retinal Neovascularization

Authors Lip PL, Kolli H, Trivedi D

Received 23 July 2020

Accepted for publication 1 September 2020

Published 1 October 2020 Volume 2020:14 Pages 2965—2974


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

Peck Lin Lip, Hemalatha Kolli, Dipti Trivedi

Birmingham and Midland Eye Centre, Birmingham, UK

Correspondence: Peck Lin Lip
Birmingham and Midland Eye Centre Sandwell & West Birmingham NHS Trust City Hospital, Dudley Road, Birmingham B18 7QH, UK
Tel +44 121 5543801
Fax +44 121 5076791

Purpose: To share the experience of using ultra-widefield fluorescein angiography (UWF-FA) in recognizing the potential signs for retinal neovascularizations (NVE) development in branch retinal vein occlusions (BRVO).
Methods: Reporting angiographic findings in 60 BRVO eyes presenting with NVE and vitreous hemorrhage using UWF-FA investigation. Angiographic retinal ischemic index (ARI) was also calculated from UWF-FA as the ratio of digitally mapped ischemic retina area against area of optic disc, termed unit of disc diameter (DD).
Results: We observed emerging angiographic features common to these patients: pattern of a localized non-perfused retina at early phase of UWF-FA remaining non-perfused at the late phase (black retinal ischemia, black-RI) (100%); presence of retinal microvascular anomalies (RMAs) at the “water-shed-border” of black-RI (100%); site of NVEs observed at either the same “water-shed-border” (42%) or from the main vessel branch within the black-RI (30%), or from both sites (28%); multiple NVEs were observed in all eyes except two with single active NVE. Median ARI size was 114 DD (SD 80 DD), range 5– 354 DD.
Conclusion: We report a recurring angiographic pattern common to eyes with active BRVO-NVEs from UWF-FA, and NVEs in this clinical group can develop from varied ARI sizes. Further studies would be needed to establish the role of UWF-FA in predicting angiographic risk factors for BRVO-NVE.

Keywords: definition, vitreous hemorrhage, ghost vessels, risk, laser

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