FUNDUS FLUORESCEIN ANGIOGRAPHY AS A DIAGNOSTIC TOOL IN AGERELATED MACULAR DEGENERATION

Background:Age related macular degeneration (ARMD) is a leading cause of severe irreversible vision impairment in developed countries. It is a hereditary degenerative condition involving the choriocapillaries, Bruchs retinal pigment epithelium and photoreceptors. Early stage disease is characterized by deposition of drusen under the RPE cells into Bruchs membrane. In late stages disease may progress to either geographic atrophy also known as Dry AMD or neovascular also known as Wet AMD. Loss of vision in dry AMD is due to photoreceptors and atrophy of RPE with loss of choriocapillaries whereas choroidal neovascularization (CNV) is associated with breakthrough of choroidal neovascular vessels through Bruchs membrane and RPE causing hemorrhagic , exudative , or disciform AMD. Although the clinical diagnosis of AMD can be established based on patients history and fundus examination, Fluorescein Angiography (FA) is the most important ancilliary test for classifying the disease in its different subtypes, especially in its wet form. Nowdays, optical coherence tomography (OCT) is being more used than FFA for monitoring the response to treatment, although FA is still very useful in some cases. FA is a powerful imaging modality to identify the presence, location and size of the neovascular complex which is composed of choroidal neovascular lesion and its components. FA is a useful diagnostic method and also an important clinicaresearch tool, displaying lesion morphology data. Many clinical trials of AMD rely on FA characterization for both eligibility and treatment endpoints.

Objectives: To assess the role of fundus fluorescein angiography in age related macular

disorders.

To know the varies types of ARMD and its pattern.

To know the progression and response to treatment in ARMD

To find neovascularisation and occult lesions

Study design: Cross sectional study

Methods: This study included 100 patients with macular pathology, who were detected to have

AMD in either eye, who presented themselves to outpatient Department of ophthalmology in SanthiRam medical college and general Hoapital,nandyal. A careful detailed history was taken regarding the duration and symptoms of

the disease followed by eye examination which included visual acuity, slit lamp

examination and macular function test. Detailed fundus examination with 90D

indirect and direct ophthalmoscope. Thorough systemic examination was done

followed by blood investigations and ECG.

Under aseptic precaution blood samples were collected from anterior cubital

vein and the following tests were carried out.

1. Complete hemogram

2. Random blood sugar

3. Fasting lipid profile

4. Serum creatinine

And urine routine was done. Medical fitness for the procedure was obtained. Patient

was explained the procedure and proper informed consent was taken after which

fundus fluorescein angiography was performed.

Results:

Totally 100 patients fulfilling the inclusion criteria were included in the study, with

an age range of 50 years and above of both gender. Dry AMD was present in 90

patients (90%) patients and 10 patients (10%) showed wet or exudative AMD.

Interpretation and conclusion:

The fluorescein angiography helped in diagnosis, type of ARMD and its further

classification. It also helped in planning treatment and its response at follow up.