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Invest Ophthalmol Vis Sci 2013;54: E-Abstract 6065.
© 2013 ARVO


Histopathologic Features of Diabetic Microangiopathy Imaged Using an Adaptive Optics Scanning Laser Fluorescein Angiography

Richard Rosen1,2, Alfredo Dubra3, Rishard Weitz1, Joseph Carroll3, Michael Dubow1,4, Alexander Pinhas1,4, Nishit Shah1, Yusufu Sulai3,5, Nicole Scripsema1,2 and Joseph Walsh1,2

1 Ophthalmology, New York Eye & Ear Infirmary, New York, NY
2 Ophthalmology, New York Medical College, Valhalla, NY
3 Ophthalmology, Medical College of Wisconsin, Milwaukee, WI
4 Ophthalmology, Mount Sinai School of Medicine, New York, NY
5 Ophthalmology, University of Rochester, Rochester, NY

Commercial Relationships: Richard Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C); Alfredo Dubra, US Patent No: 8,226,236 (P); Rishard Weitz, None; Joseph Carroll, Imagine Eyes, Inc. (S); Michael Dubow, None; Alexander Pinhas, None; Nishit Shah, None; Yusufu Sulai, None; Nicole Scripsema, None; Joseph Walsh, None

Support: None


Purpose:To describe the fluorescein angiographic features of diabetic microangiopathy lesions imaged with an adaptive optics scanning light ophthalmoscope (AOSLO) compared to their appearance on conventional fundus photography and spectral domain optical coherence tomography (SDOCT).

Methods:AOSLO images (790nm; 1° degree field of view) without fluorescein dye were collected in 15 adult diabetic retinopathy patients to identify microvascular points of interest. Patients then ingested 1gm fluorescein dye mixed in 4oz of orange juice. Simultaneous reflectance (790 nm) and fluorescence (488 nm excitation, 503-548 nm emission) AOSLO images (1° field of view) were collected between 15 and 60 minutes post-ingestion. For comparison with conventional imaging techniques, fundus imaging with and without intravenous fluorescein were performed.

Results:In the fluorescence AOSLO channel we were able to visualize microangiopathic features of diabetic microangiopathy in vivo at the level of the retinal capillary bed. A number of lesions were clearly delineated, including a variety of microaneurysms, capillary loops, IRMA, and neovascularization, which could not be seen well in the 790nm channel. These lesions typically appeared as red dots on fundus photography or bright spots on clinical fluorescein angiography. OCT appearances were typically less distinct.

Conclusions:Micro fluorescein angiography can by successfully and safely achieved using AOSLO in diabetic patients revealing anatomic features previously seen only on pathology slides. This level of clinical imaging may prove useful for evaluating the impact of treatment at a the microscopic scale.

Figure 01
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Figure 1. A:Segment of wide field fundus photograph demonstrating microaneurysms, tortuosity, and neovascularization. B:Standard wide field fluorescein angiogram with color coded frames corresponding to micro angiographic images in figure 2. C:Corresponding SD-OCT slice through the red frame revealing microaneurysms


Figure 02
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Figure 2. AOSLO FA images corresponding to frames in figure 1 revealing details of microangiopathy including vascular loops (A,B,C) microaneurysms(A,B,C), and capillary dropout( A, B,C).


Keywords: 550 imaging/image analysis: clinical • 499 diabetic retinopathy • 688 retina

© 2013, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Permission to republish any abstract or part of an abstract in any form must be obtained in writing from the ARVO Office prior to publication.