| Uveitis is a kind of common diseases in clinical ophthalmology, and most of uveitis are associated with fundus inflammatory changes, so fundus fluorescein angiography(FFA) is an essential tool in the judgement and record of disease activity, in order to supplementarily determine treatment options.Traditional FFA can only capture the fundus image in 30o to 60o wide field in one image. Although conventional fundus photography with montage can get a wider field, the operation is more complicated, and can not get the image of the same FFA stage.These limitations make it difficult to record and compare the peripheral fundopathy logitudinally in clinical examination and follow-up, so clinicians can only judge the changes of disease depending on manual drawing, standard fundus pictures and their memory, which limits the clinicians’ judgement on inflammatory activity and follow-up treatment of uveitis.In recent years, several ultra-wide-field FFA devices have been applied to clinical research and shown different characteristics, also played an important role in research of many kinds of fundopathy.There are a few articles on uveitis studied by usage of ultra-wide-field FFA being published in international journals from 2009, accompanied by some new findings, however, there are very few related research papers published in national journals. In this study, ultra-wide-field FFA is performed to many kinds of uveitis patients by usage of Heidelberg Spectralis non-contact fundus imaging devices, in order to analyze the imaging feature and evaluate the clinical application value of ultra-wide-field FFA in the diagnosis and management of uveitis, and improve the recognition and treatment level of uveitis.Objective:To evaluate the clinical application value of ultra-wide-field FFA in the diagnosis and management of uveitis, in order to improve the recognition and treatment level of uveitis.Methods:61 eyes of 35 continue uveitis patients were selected by the inclusion and exception criterion in this study, and their information including the anatomic types, frequency and duration of uveitis were recorded.All these eyes were examined by Heidelberg retina angiography to perform ultra-wide-field FFA.In the early and middle stages of FFA, 55o front lens was used to capture the fundus images as much wide field as possible; in the middle stage of FFA,102o front lens replaced the 55o front lens to do the same work; and in the late stage of FFA, 55o front lens was reused until the end stage to record the fundus fluorescence changes.After capture operation, the clear and representative images were selected and saved for analysis and research.All these images were captured by one experienced technician and analyzed by two ophthalmologists specialized on fundus diseases. First judgement of inflammatory activity was made only depending on 55o FFA images,then 102o FFA images were provided to compare the judgement with the former.Results:1 The number of eyes with peripheral fundopathy detected by two different FFA modesThe 55o FFA revealed 19 eyes(31.1%)with peripheral fundopathy, while the 102o FFA revealed 50 eyes(82.0%)with peripheral fundopathy.There is statistically significant difference(P = 0.00093)between the number of eyes with peripheral fundopathy detected by two different FFA modes.In the 33 eyes with anterior uveitis, 55o FFA revealed 8 eyes(24.2%)with peripheral fundopathy, while 102o FFA detected 27 eyes( 81.8%) with peripheral fundopathy.In the 12 eyes with intermediate uveitis, 55o FFA revealed 4 eyes(33.2%)with peripheral fundopathy, 102o FFA revealed 10 eyes(83.3%)with peripheral fundopathy.In the 10 eyes with posterior uveitis, 55o FFA revealed 4 eyes(40.0%)with peripheral fundopathy, 102o FFA revealed 8 eyes(80.0%)with peripheral fundopathy.In the 6 eyes with panuveitis, 55o FFA revealed 3 eyes(50.0%)with peripheral fundopathy, 102o FFA revealed 5 eyes(83.3%)with peripheral fundopathy.2 The number of eyes with different types of peripheral fundopathy in different anatomic types of uveitisIn the 33 eyes with anterior uveitis, 23 eyes(69.7%)were detected with peripheral vessel leakage, 2 eyes(6.1%)were detected with nonperfusion, 2 eyes(6.1%)were detected with retinal cysts.In the 12 eyes with intermediate uveitis, 8 eyes(66.7%)were detected with peripheral vessel leakage, 2 eyes(16.7%)were detected with nonperfusion.In the 10 eyes with posterior uveitis, 8 eyes(80.0%)were detected with peripheral vessel leakage, 2 eyes(20.0%)were detected with nonperfusion.In the 6 eyes with panuveitis, 5 eyes(83.3%)were detected with peripheral vessel leakage, 2 eyes(33.3%)were detected with nonperfusion, 1 eye( 16.7%) was detected with neovascularization.3 The number of eyes in which the judgement of inflammatory activity and management were changed after 102° FFA performed.After 102° FFA performed, the judgement of inflammatory activity were changed in 12 eyes with anterior uveitis, 5 eyes with intermediate uveitis, 3 eyes with posterior uveitis and 2 eyes with panuveitis.The main manifestation is peripheral vessel leakage in eyes without fundopathy found by traditional examination. And the management were changed in 19 eyes, including continued corticosteroid therapy in 9 eyes, the dosage of corticosteroid changed in 6 eyes and peripheral photocoagulation in 7eyes.(2 changes ocuured in several eyes).Conclusion:1 Eyes with anterior uveitis may occur inflammatory fundopathy, most of which are in the retinal periphery, difficult to be detected by traditional FFA, but easy to be found by ultra-wide-field FFA.It is of great significance.2 Most fundopathy of posterior uveitis and panuveitis are in the posterior pole, easy to be detected by traditional FFA, but ultra-wide-field FFA can detect more peripheral fundopathy.3 The ultra-wide-field FFA can capture peripheral fundopathy more easily. It is an important supplementary examination for ophthalmologist to judge the inflammatory activity and make management of uveitis, should be widely applied. |
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