PERIPHERAL RETINAL EVALUATION COMPARING FUNDUS PHOTOGRAPHS WITH FLUORESCEIN ANGIOGRAMS IN PATIENTS WITH DIABETES-MELLITUS

Purpose: To evaluate peripheral nonproliferative retinopathy by compar ing fundus photograph changes with angiographic findings in type 1 dia betic patients with a long duration of diabetes. Methods: Thirty-eight patients with type 1 diabetes, without proliferative retinopathy and with at least 30 years of diabetes duration, were selected to be exami ned with fundus photography and fluorescein angiography. Two levels of retinopathy degree were identified. In fundus photographs, level 1 re presented eyes with no or mild peripheral background retinopathy (i.e. , five or fewer pinpoint hemorrhages or microaneurysms), and level 2, peripheral moderate retinopathy (i.e., dot-and-blot hemorrhages or int raretinal microvascular abnormalities or cotton-wool spots). In the an giograms, level 1 represented a nearly normal vascular pattern with oc casional microaneurysms and level 2 comprised morphologic signs of abn ormal circulation such as dilated capillaries, arteriolar abnormalitie s, intraretinal microvascular abnormalities, and capillary loss of 3 o r more disk diameters from the center of the macula. The angiograms an d fundus photographs were graded separately and the results of the gra ding were compared. Results: The peripheral parts of the retina could be visualized with a high photographic quality an both fundus photogra phs and angiograms in 66 eyes. On fundus photographs, both graders fou nd level 1 retinopathy in 47 of 66 eyes and level 2 retinopathy in 13 of 66 eyes. On angiograms, both graders found level I retinopathy in 4 6 of 66 eyes, whereas level 2 retinopathy was seen in 16 of 66 eyes. I n most eyes with no or mild retinopathy, the angiograms were interpret ed as nearly normal (41 of 47), and in most eyes with moderate retinop athy, they were interpreted as abnormal (10 of 13). Conclusion: The de gree of peripheral diabetic retinal changes based on grading of fundus photographs was comparable to that based on angiograms in 51 of 66 (7 7%) eyes.