Abstract：
OBJECTIVE: In early 2022, a fluorescein shortage occurred in the United States. To meet the standard of care for patients who required ultrawidefield fundus fluorescein angiography (UWFFA), a regimen of half-dose (250 mg) sodium fluorescein (10%) was adopted instead of the full dose (500 mg) at the Cole Eye Institute (CEI). In this paper, we compare the image quality, clinical utility, and the side-effect profile of half-dose versus full-dose fluorescein in UWFFA for a cohort of stable patients.
METHODS: Retrospective chart review.
METHODS: Patients with retinal vascular disease were included if they received half-dose and full-dose UWFFA (Optos California) within 6 months at the CEI. Eyes were excluded if they received intraocular injections, laser procedures, new immunosuppression, and worsened or improved inflammation on clinical examination.
METHODS: Quantitative assessment of vascular leakage was performed using a machine learning-enhanced automated segmentation platform. Leakage from late-phase UWFFA images was compared between half-dose and full-dose images. Qualitative assessment of image quality and relative vascular leakage was performed by 2 masked independent reviewers. Side effects after fluorescein administration were recorded for each patient.
METHODS: Masked leakage grading and automated leakage scores.
RESULTS: There were 52 eyes of 35 patients, 42 (81%) uveitic, 5 (9%) diabetic, and 4 (8%) normal controls. Patients had no change to their visual acuity (logarithm of the minimum angle of resolution mean, 0.3 ± 0.6), anterior chamber and vitreous cell between UFFWA\'s. UWFFA images were deemed of equal quality and leakage by both masked reviewers (78%-87% agreement; κ, 0.642). Automated leakage analysis showed mildly increased leakage in half-dose images overall (3.8% vs. 2.8%; P = 0.01) and in the macula (1.5% vs. 0.6%; P = 0.01). Side effects included nausea (half [n = 3, 9%] vs. full [n = 2, 6%]; P = 0.69) and urticaria (n = 0, 0% vs. n = 1, 2%; P = 0.99) and were not different between doses.
CONCLUSIONS: In this cohort, half-dose UWFFA produced images that were of similar quality, clinical utility and with a similar side effect profile compared with full dose. Half-dose UWFFA can be used to accurately assess the retinal vasculature and could be used primarily as a method to save cost and prevent waste.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
METHODS: Retrospective chart review.
METHODS: Patients with retinal vascular disease were included if they received half-dose and full-dose UWFFA (Optos California) within 6 months at the CEI. Eyes were excluded if they received intraocular injections, laser procedures, new immunosuppression, and worsened or improved inflammation on clinical examination.
METHODS: Quantitative assessment of vascular leakage was performed using a machine learning-enhanced automated segmentation platform. Leakage from late-phase UWFFA images was compared between half-dose and full-dose images. Qualitative assessment of image quality and relative vascular leakage was performed by 2 masked independent reviewers. Side effects after fluorescein administration were recorded for each patient.
METHODS: Masked leakage grading and automated leakage scores.
RESULTS: There were 52 eyes of 35 patients, 42 (81%) uveitic, 5 (9%) diabetic, and 4 (8%) normal controls. Patients had no change to their visual acuity (logarithm of the minimum angle of resolution mean, 0.3 ± 0.6), anterior chamber and vitreous cell between UFFWA\'s. UWFFA images were deemed of equal quality and leakage by both masked reviewers (78%-87% agreement; κ, 0.642). Automated leakage analysis showed mildly increased leakage in half-dose images overall (3.8% vs. 2.8%; P = 0.01) and in the macula (1.5% vs. 0.6%; P = 0.01). Side effects included nausea (half [n = 3, 9%] vs. full [n = 2, 6%]; P = 0.69) and urticaria (n = 0, 0% vs. n = 1, 2%; P = 0.99) and were not different between doses.
CONCLUSIONS: In this cohort, half-dose UWFFA produced images that were of similar quality, clinical utility and with a similar side effect profile compared with full dose. Half-dose UWFFA can be used to accurately assess the retinal vasculature and could be used primarily as a method to save cost and prevent waste.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
摘要：
目标：2022年初，美国发生了荧光素短缺。为了满足需要超宽眼底荧光血管造影（UWFFA）的患者的护理标准，Cole眼科研究所(CEI)采用半剂量(250mg)荧光素钠(10%)而不是全剂量(500mg)的方案.在本文中,我们比较图像质量，临床效用，以及一组稳定患者的UWFFA中半剂量与全剂量荧光素的副作用。
方法：回顾性图表回顾。
■如果接受半剂量和全剂量UWFFA（OptosCalifornia，邓弗姆林,英国）在CEI的6个月内。如果他们接受眼内注射，眼睛被排除在外，激光程序，新的免疫抑制，临床检查炎症恶化或改善。
■使用机器学习增强的自动分割平台对血管渗漏进行定量评估。在半剂量和全剂量图像之间比较了晚期UWFFA图像的泄漏。图像质量和相对血管渗漏的定性评估由2名蒙面独立评审员进行。记录每位患者施用荧光素后的副作用。
方法：屏蔽渗漏分级和自动渗漏评分。
结果：35例患者共52只眼，42（81%）葡萄胎，5（9％）糖尿病，和4个（8％）正常对照。患者视力无变化（LogMAR平均0.3±0.6），前房和玻璃体之间的UFFWA\'s。UWFFA图像被两位蒙面评论者认为质量和泄漏相等(78-87%的同意，卡帕0.642)。自动泄漏分析显示，半剂量图像的泄漏总体上略有增加（3.8％vs2.8％，p=0.01),在黄斑中(1.5%对0.6%，p=0.01)。副作用包括恶心（一半（n=3，9％）vs完全（n=2，6％），p=0.69）和荨麻疹（n=0，0%vsn=1，2%，p=0.99），剂量之间没有差异。
结论：在这个队列中，半剂量UWFFA产生的图像质量相似，与全剂量相比，临床实用性和类似的副作用。半剂量UWFFA可用于准确评估视网膜脉管系统,并且可主要用作节省成本和防止浪费的方法。
方法：回顾性图表回顾。
■如果接受半剂量和全剂量UWFFA（OptosCalifornia，邓弗姆林,英国）在CEI的6个月内。如果他们接受眼内注射，眼睛被排除在外，激光程序，新的免疫抑制，临床检查炎症恶化或改善。
■使用机器学习增强的自动分割平台对血管渗漏进行定量评估。在半剂量和全剂量图像之间比较了晚期UWFFA图像的泄漏。图像质量和相对血管渗漏的定性评估由2名蒙面独立评审员进行。记录每位患者施用荧光素后的副作用。
方法：屏蔽渗漏分级和自动渗漏评分。
结果：35例患者共52只眼，42（81%）葡萄胎，5（9％）糖尿病，和4个（8％）正常对照。患者视力无变化（LogMAR平均0.3±0.6），前房和玻璃体之间的UFFWA\'s。UWFFA图像被两位蒙面评论者认为质量和泄漏相等(78-87%的同意，卡帕0.642)。自动泄漏分析显示，半剂量图像的泄漏总体上略有增加（3.8％vs2.8％，p=0.01),在黄斑中(1.5%对0.6%，p=0.01)。副作用包括恶心（一半（n=3，9％）vs完全（n=2，6％），p=0.69）和荨麻疹（n=0，0%vsn=1，2%，p=0.99），剂量之间没有差异。
结论：在这个队列中，半剂量UWFFA产生的图像质量相似，与全剂量相比，临床实用性和类似的副作用。半剂量UWFFA可用于准确评估视网膜脉管系统,并且可主要用作节省成本和防止浪费的方法。
