The importance of fluorescein angiography in planning laser treatment of diabetic macular edema
Section snippets
Study design-analysis of treatment accuracy
Stereo color fundus photographs and a fluorescein angiogram were collected for 100 eyes of 96 patients with clinically diagnosed CSME. Standard treatment maps were developed for each eye, by consensus, by two experienced retina specialists based on the ETDRS treatment protocol (Fig 1). 2, 5 The maps were sketched on a sheet of transparent plastic placed over a color image of the fundus projected on a slide viewer; they consisted of areas of grid treatment, focal treatment spots, and location of
Case characteristics
Table 1 lists the frequency of occurrence of various posterior pole characteristics in our case set.
Effect of fluorescein angiography on accuracy of treatment maps
Treatment maps created using a fluorescein angiogram were more accurate than those created without the benefit of a fluorescein angiogram when looking at combined, grid, and focal treatment (Table 2). The effects of FA on combined and grid overtreatment were not statistically significant, but focal overtreatment increased after FA (P < 0.001).
Effect of fluorescein angiography on ability to detect macular ischemia
The 2 specialists who created the standard treatment
Discussion
The most direct way to test our hypothesis that FA does not improve treatment of patients with CSME would be to perform a randomized, prospective, clinical study in which patients were treated with and without the benefit of FA and in which visual acuity was the major outcome variable. Such a study, however, is impractical because it would have to be very large and extremely expensive. For this reason, we used an indirect approach to test the same hypothesis. We sought to determine whether FA
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