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Topographic Documentation of Retinal Leakage-areas Following Branch Retinal Vein Occlusion

1Hillmann K., 1Müller-Velten R., 2Birngruber R., 1Schmidt-Erfurth U.,
1Medizinische Universität zu Lübeck, Klinik für Augenheilkunde (Lübeck)
2Medizinisches Laserzentrum Lübeck GmbH (Lübeck)

Purpose: Branch retinal vein occlusion (BRVO) induces retinal leakage of variable extent and intensity. A novel three-dimensional angiographic technique was evaluated in respect to identification of leakage areas and documentation of therapeutic laser effects.
Method: In a prospective pilot study, 30 patients with BRVO and clinically significant macular edema (CSME) underwent fluorescein (FA) and indocyanine green angiography (ICGA) within 6 weeks of the event. A confocal laser scanning ophthalmoscope (Heidelberg Retina Angiograph) was used to produce 32 tomographic serial sections within a depth of 4 mm. The axial distribution of fluorescence within the entire series was determined and displayed in its three-dimensional topography.
Results: Thrombotic areas with impaired perfusion and increased vascular permeability demonstrated a well-demarcated retinal prominence compared to flat areas with intact barrier function. Masking phenomena due to intraretinal hemorrhage seen by conventional FA/ICGA did not compromise topographic FA/ICGA. By 3D-FA leakage areas were detected in 75% during early and in 84% of all examinations during late frames. Areas of exudation were most effectively documented by 3D-ICGA with 85% positive cases in early and 90% positive cases in late frames. The dimension of leakage areas was measured with 19 mm2 by FA- and with 18 mm2 by ICGA topography. Focal laser coagulation in eyes with CSME led to a significant reduction in retinal thickening in all treated eyes. Laser-induced lesions imposed as focal perfusion defects within the choriocapillary layer seen 3 months after treatment.
Conclusions: Topographic angiography allows documentation of retinal vascular permeability changes. Extent and intensity of intraretinal leakage before and after laser treatment are clearly identified.