Diabetic retinopathy is a common blinding complication in diabetic patients. Compared with conventional fundus color photography, fundus fluorescein angiography can dynamically display retinal vessel permeability changes, offering unique advantages in detecting early small lesions such as microaneurysms. However, existing intelligent diagnostic research on diabetic retinopathy images primarily focuses on fundus color photography, with relatively insufficient research on complex lesion recognition in fluorescein angiography images. This study proposed an adaptive multi-label classification model (D-LAM) to improve the recognition accuracy of small lesions by constructing a category-adaptive mapping module, a label-specific decoding module, and an innovative loss function. Experimental results on a self-built dataset demonstrated that the model achieved a mean average precision of 96.27%, a category F1-score of 91.21%, and an overall F1-score of 94.58%, with particularly outstanding performance in recognizing small lesions such as microaneurysms (AP = 1.00), significantly outperforming existing methods. The research provides reliable technical support for clinical diagnosis of diabetic retinopathy based on fluorescein angiography.
Diabetic Retinopathy/diagnostic imaging* ; Humans ; Fluorescein Angiography ; Microaneurysm/diagnostic imaging* ; Retinal Vessels ; Algorithms

Background: Contrast-induced nephropathy (CIN) is a complication that occurs in patients undergoing an imaging procedure with intravenous injection of contrast media, most notably iodinated dyes. Fluorescein angiography is a diagnostic procedure performed by ophthalmologists to determine abnormalities in retinal blood vessels. It uses sodium fluorescein, an organic dye, to capture and visualize these blood vessels. There have been conflicting data and practices on how to approach the procedure especially in patients with renal insufficiency. Objective: To determine the risk of CIN among patients undergoing fluorescein angiography. Methods: We searched PubMed, HerdIn, Cochrane Library, and Google Scholar, for published articles on the topic. Other sources were searched for unpublished data or ongoing clinical trials. All research articles pertaining to fluorescein angiography and its effect on renal function with serum creatinine monitoring were included. Two independent authors separately screened records, assessed full texts, and extracted data. We used RevMan computer software to analyze data from the included studies. The primary outcome was the risk of CIN among patients undergoing fluorescein angiography based on the differences on serum creatinine levels and estimated glomerular filtration rates pre- and post-angiography, while the secondary outcome included risk factors for CIN. Results: A total of 6 studies were included in the meta-analysis. Four studies had poor quality as assessed using the Newcastle-Ottawa Scale. One study was deemed to have good quality. Data analysis showed that hemoglobin (p = 0.002) and albumin (p < 0.001) levels may be associated with CIN using sodium fluorescein but were not independent risk factors for CIN (multivariable logistic regression, p = 0.648 and p = 0.069, respectively); while sex, diabetes mellitus and chronic kidney disease were not significantly associated. As a primary outcome, only 6.8% of included patients had CIN with serum creatinine levels post-exposure showed significant differences from baseline values (mean difference 0.05; 95% CI 0.02, 0.07; I2 = 49%), but translating it to eGFR yielded non-significant differences (mean difference -0.37; 95% CI -2.33, 1.59; I2 = 0%). Conclusion Among patients undergoing fluorescein angiography, sodium fluorescein does not pose an increased risk for CIN.
fluorescein angiography ; renal function

Objective The main objective of this study is to determine the agreement between the clinical staging of diabetic retinopathy (DR) with fluorescein angiography (FA) staging in an actual clinic.
Diabetic Retinopathy ; Fluorescein Angiography ; Ophthalmoscopy ; Diabetes Mellitus

OBJECTIVES: Central serous chorioretinopathy (CSC) is generally a common fundus disease in young and middle-aged Asian men. Acute and chronic CSC can lead to different degrees of injury to the retinal blood flow. This study aims to observe and compare the blood flow density in different retinal capillary layers in patients with acute and chronic CSC using optical coherence tomography angiography (OCTA) technology. METHODS: Twelve patients with acute CSC and 8 patients with chronic CSC including 12 eyes with acute CSC (acute CSC eye group), 11 eyes with chronic CSC (chronic CSC eye group), and 17 normal eyes (normal eye group) were enrolled in this study. All patients underwent 3 mm×3 mm, 6 mm×6 mm macular OCTA scanning. The retinal microvascu-lature was divided into superficial vascular complexes (SVC), intermediate capillary plexuses (ICP), and deep capillary plexuses (DCP) using the projection resolved-OCTA algorithm. Inner retina includes SVC, ICP, and DCP. The vessel density in each retinal layer and the inner retina were calculated and compared. RESULTS: Macular OCTA scanning of 3 mm×3 mm showed that there was no significant difference in blood flow density of SVC and ICP among the 3 groups (both P>0.05); blood flow density of DCP and inner retina in the chronic CSC eye group was significantly lower than that in the acute CSC eye group and the normal eye group (all P<0.05); there was no significant difference in retinal blood flow density of different layer between the acute CSC eye group and the normal eye group (all P>0.05). Macular OCTA scanning of 6 mm×6 mm showed that inner retinal blood flow density of the chronic CSC eye group was significantly lower than that of the acute CSC eye group and the normal eye group (both P<0.05); there was no significant difference in blood flow density of SVC among the 3 groups (P>0.05). CONCLUSIONS The vessel density of DCP and inner retina in the eyes with chronic CSC are significantly reduced, which may result in impaired visual function. Therefore, we recommend that patients with acute CSC should be properly treated to avoid progressing into chronic CSC.
Central Serous Chorioretinopathy/diagnostic imaging* ; Fluorescein Angiography/methods* ; Humans ; Male ; Microvessels/diagnostic imaging* ; Middle Aged ; Retina ; Tomography, Optical Coherence/methods*

OBJECTIVE: To evaluate the value of fundus autofluorescence (FAF) imaging combined with spectral domain optical coherence tomography (SD-OCT) in diagnosis, prognostic assessment and follow-up observation of acute Vogt-KoyanagiHarada (VKH) disease. METHODS: Clinical data were collected from 12 patients (23 eyes) with acute VKH disease treated in our hospital from May, 2018 to November, 2019, including detailed medical history, best corrected visual acuity (BCVA), and results of slit lamp biomicroscopy, fundus photography, SD-OCT, fundus fluorescein angiography (FFA) and FAF imaging.SDOCT and FAF imaging were repeated after a course of treatment and in follow-up examination, and the results were compared with those at the time of admission. RESULTS: VKH disease involved both eyes in 11 patients (91.7%).Fundus photography showed optic disc edema in 16 eyes (69.6%), and multiple retinal neuroepithelial detachment was detected by SD-OCT in all the involved eyes (100%).IN all the eyes, FFA revealed small and dense fluorescein leakage in the early stage and fluorescein accumulation in advanced stages of VHK disease to form multiple dye pooling in the areas of serous detachment.Hyperauto fluorescence was a common finding in FAF imaging (100%), and the area involved was consistent with that of fluorescein accumulation shown by FAF imaging.Ten eyes (43.5%) showed patches of relative hypoautofluorescence in the hyperauto fl uorescence areas, and granular hyperauto fl uorescence was found in the lesions in 4 eyes (17.4%).During the remission period of VKH disease, FAF imaging showed normal finding in 8 eyes (34.8%) and reduced areas (by 55.2%) and intensity (by 46.5%) of hyperautofluorescence in 9 eyes (39.1%).In 6 eyes (26.1%), only a few hyperautofluorescent spots scattered in the macula were observed.SD-OCT demonstrated significantly reduced (by 69.5% on average) or even disappearance of subretinal fluid in the eyes.The fluorescence intensity in FAF imaging showed a significant positive correlation with the volume of subretinal fluid detected by SD-OCT ( CONCLUSIONS The combination of fluorescein angiography, FAF imaging and SD-OCT can significantly improve the diagnostic accuracy of VKH disease.FAF imaging combined with SD-OCT provides an effective and noninvasive modality for evaluation of remission and monitoring the changes in VKH disease.
Acute Disease ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Retinal Detachment/diagnostic imaging* ; Tomography, Optical Coherence ; Uveomeningoencephalitic Syndrome/diagnostic imaging*

OBJECTIVE: To determine the incidence of contrast-induced nephropathy (CIN) among patients undergoing fundus fluorescein angiography (FFA) METHODS: One hundred fifty-nine (159) patients from the Ophthalmology out-patient department were enrolled in this prospective, observational study. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were measured within 7 days before and 48 to 72 hours after FFA. Subjects were stratified into low-, intermediate-, and high-risk groups for developing CIN according to baseline eGFR. CIN was defined by an increase in SCr by more than 25% or by 0.5 mg/dL within 72 hours of intravascular administration of contrast media. The incidence of CIN, changes in SCr levels, and changes in eGFR were analyzed. RESULTS: Of the 144 subjects who completed the study, 106 (73.6%) were females, 105 (72.9 %) were diabetics, and 57 (39.6%) had elevated baseline SCr. Four (4 or 2.8%) patients developed CIN after FFA, all of whom had normal baseline SCr and were stratified as low-risks. Overall, there were no significant changes in the means of SCr (1.18 ± 0.56 vs 1.16 ± 0.52, p = 0.13) and eGFR (64.53 ± 26.05 vs 64.94 ± 24.88, p = 0.64) before and after FFA. In the low-risk group, the means of SCr and eGFR remained unchanged after FFA (p = 0.06 and p = 0.15, respectively). In the intermediate-risk group, no significant change was appreciated in SCr levels (p = 0.07) however a significant improvement in eGFR (p = 0.006) was seen. Interestingly, a significant decrease in SCr levels (p = 0.004) as well as a significant improvement in eGFR (p = 0.02) was noted after FFA in the high-risk group. CONCLUSION: The incidence of CIN among patients undergoing FFA in our cohort was 2.8%. There was no prolonged or serious worsening of renal function based on SCr and eGFR before and after FFA overall, and among low-, moderate-, and high-risk groups.
Creatinine ; Glomerular Filtration Rate ; Contrast Media ; Incidence ; Fluorescein Angiography ; Acute Kidney Injury ; Drug-Related Side Effects and Adverse Reactions

PURPOSE: To report a case of central serous chorioretinopathy with peripapillary retinoschisis. CASE SUMMARY: A 64-year-old male presented with abnormal color vision of the left eye, which occurred 6 months prior to his visit. At the initial visit, a funduscopic examination revealed retinal elevation with suspected serous retinal detachment around the optic disc in the left eye. Spectral domain optical coherence tomography showed subretinal fluid on the nasal side of the optic disc and retinoschisis on the temporal side of the optic disc in the left eye. Fluorescein angiography revealed multiple leakages in the left eye. Indocyanine green angiography revealed choroidal vascular hyperpermeability in both eyes. Based on these results, the patient was diagnosed with chronic central serous chorioretinopathy and was treated with argon laser photocoagulation at the leakage points. After 8 weeks of laser therapy, optical coherence tomography indicated that there was no retinoschisis or subretinal fluid in the macula, nasal, or temporal sides of the optic disc. CONCLUSIONS: Peripapillary retinoschisis due to central serous chorioretinopathy improves with argon laser photocoagulation at leakage sites.
Angiography ; Argon ; Central Serous Chorioretinopathy ; Choroid ; Color Vision ; Fluorescein Angiography ; Humans ; Indocyanine Green ; Laser Therapy ; Light Coagulation ; Male ; Middle Aged ; Retinal Detachment ; Retinaldehyde ; Retinoschisis ; Subretinal Fluid ; Tomography, Optical Coherence

PURPOSE: To report a case of frosted branch angiitis (FBA) associated with Epstein-Barr virus (EBV) infection in a child. CASE SUMMARY: A 7-year-old boy presented with bilateral blurred vision. On ophthalmic examination, his best-corrected visual acuity was 20/25 in the right eye and 20/32 in the left eye. The pupils were equal, round, and reactive to light without a relative afferent pupillary defect. He had normal color vision in both eyes. Slit-lamp examination revealed no abnormalities in the anterior parts of the eyes. Fundoscopic examination revealed prominent white sheathing retinal vasculitis predominantly on the veins in all quadrants, as well as macular edema and irregular foveal reflex in both eyes. Fluorescein angiography showed normal blood flow, but late diffuse staining and leakage of the affected vessels. Spectral domain optical coherence tomography (SD-OCT) showed thickening of the vessel walls, swelling due to hyperreflective material, and hyperreflective retinal depositions. Serological tests and the serum polymerase chain reaction for EBV were positive. A diagnosis of FBA associated with EBV was made. He was treated with systemic acyclovir and steroids. The response was rapid, with improvement in visual acuity to 20/20 in both eyes by day 3. After 7 weeks, all clinical signs resolved and SD-OCT examination showed normal vessel wall thickness and the absence of hyperreflective depositions. CONCLUSIONS: EBV may present with FBA even in the absence of a systemic sign of primary EBV infection. Thus, EBV should be considered as the etiology of FBA.
Acyclovir ; Child ; Color Vision ; Diagnosis ; Epstein-Barr Virus Infections ; Fluorescein Angiography ; Herpesvirus 4, Human ; Humans ; Macular Edema ; Male ; Polymerase Chain Reaction ; Pupil ; Pupil Disorders ; Reflex ; Retinal Vasculitis ; Retinaldehyde ; Serologic Tests ; Steroids ; Tomography, Optical Coherence ; Vasculitis ; Veins ; Visual Acuity

PURPOSE: To report a case of choroidal neovascularization in a Best disease patient treated with intravitreal bevacizumab injection and followed up with optical coherence tomography angiography (OCTA). CASE SUMMARY: A 20-year-old female visited our clinic with decreased visual acuity of the left eye for 6 months. On optical coherence tomography (OCT), subretinal fluid and hyperreflective subretinal clumps were observed in the macula of the right eye. Subretinal hemorrhage and subretinal fluid were observed in the left eye. Choroidal neovascularization in the left eye was observed using OCTA, fluorescein angiography, and indocyanine green angiography. A full-field electroretinogram was normal in both eyes, but an electrooculogram revealed that the Arden ratio was 1.564 in the right eye and 1.081 in the left eye. Intravitreal bevacizumab injection was performed in the left eye. At 6 months after the intravitreal injection, the best-corrected visual acuity of the left eye had recovered to 20/20. OCT revealed that subretinal fluid reduced and choroidal neovascularization was stable. After 12 months, visual acuity of the left eye was maintained at 20/20, but OCTA revealed that choroidal neovascularization had increased. CONCLUSIONS: Choroidal neovascularization associated with Best disease can improve by intravitreal bevacizumab injection, and the changes in choroidal neovascularization can be followed using OCTA.
Angiography ; Bevacizumab ; Choroid ; Choroidal Neovascularization ; Electrooculography ; Female ; Fluorescein Angiography ; Hemorrhage ; Humans ; Indocyanine Green ; Intravitreal Injections ; Subretinal Fluid ; Tomography, Optical Coherence ; Visual Acuity ; Vitelliform Macular Dystrophy ; Young Adult

PURPOSE: Although there are significant risks, retrobulbar anesthesia is commonly used for eye surgery. We report two cases of Purtscher-like retinopathy, a rare complication. CASE SUMMARY: (Case 1) A 76-year-old female visited our hospital because of decreased vision. She underwent right cataract surgery with retrobulbar anesthesia. After 7 days, she had decreased visual acuity (VA) and a constricted visual field. Multiple white spots and cotton wool spots around the optic nerve and post pole, macular edema (ME), and subretinal fluid (SRF) were found using a fundus examination. A non-perfusion area and staining of the vascular wall were seen using fluorescence angiography. Although carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were performed, the ME and SRF persisted. After intravitreal aflibercept was injected twice (2-month interval), the ME and SRF decreased and remained stable. (Case 2) A 61-year-old male underwent left cataract surgery with retrobulbar anesthesia. After anesthesia, the VA of the left eye was 10 cm finger count. The fundus examination showed multiple hemorrhage blots and retinal hemorrhages, and hyperfluorescence around the optic nerve and post pole; vascular wall staining revealed a Purtscher-like retinopathy. Left carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were then performed. After treatment, the VA of the left eye, ME, and SRF were improved at the 4-month follow-up. CONCLUSIONS: We report rare complications of retrobulbar anesthesia, with active and timely treatment having a positive impact on the visual prognosis.
Aged ; Anesthesia ; Angiography ; Cataract ; Dental Caries ; Female ; Fingers ; Fluorescein Angiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Injections, Intravenous ; Macular Edema ; Male ; Middle Aged ; Optic Nerve ; Prognosis ; Retinal Hemorrhage ; Steroids ; Subretinal Fluid ; Visual Acuity ; Visual Fields ; Wool