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Editors Selection IGR 9-4
Clinical Examination Methods: Diagnosis of neovascular glaucoma
Comment by Wallace Alward on:
53551 RETCAM FLUORESCEIN GONIOANGIOGRAPHY: A New Modality for Early Detection of Angle Neovascularization in Diabetic Retinopathy, Azad R; Arora T; Sihota R et al., Retina (Philadelphia, Pa.), 2013; 33: 1902-1907
Azad and colleagues describe the use of fluorescein angiography of the iridocorneal angle with the RetCam® to diagnose neovascularization of the angle in patients with diabetic retinopathy.
Ten (20%) of 50 eyes with severe or very severe non-proliferative diabetic retinopathy were found to have angle neovascularization using this technique, compared with 10% on gonioscopy
They examined 150 eyes of 150 patients with a wide variety of severity of diabetic retinopathy. One examiner performed conventional gonioscopy and a second examiner performed fluorescein gonioangiography. They used a variation of a technique described by Mizuo in 1913 that employs fluid in the cul-de-sac to overcome total internal reflection. By filling the cul-de-sac with methylcellulose Azad et al. were able to directly photograph the angle with and without fluorescein.
They found that conventional gonioscopy diagnosed neovascularization of the angle in 14.66% of their patient population while fluorescein angiography with the RetCam® found neovascularization in 24.66% (p = 0.04). Ten (20%) of 50 eyes with severe or very severe non-proliferative diabetic retinopathy were found to have angle neovascularization using this technique, compared with 10% on gonioscopy. The authors point out that this could be a valuable means of estimating the severity of retinopathy in eyes where there is no view of the fundus due, for example, to vitreous hemorrhage. Any procedure that would encourage us to look at the iridocorneal angle is to be applauded. I am concerned that the very high cost of the RetCam® (currently over $ 90,000) and the inconvenience of performing angiography at most institutions will prevent this from finding widespread application.
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