Takayasu Retinopathy Findings on Ultra-Wide Field Fundus Fluorescein Angiography

Purpose: To evaluate the role of ultra-widefield Fundus fluorescein angiography (UWF-FFA) in patients with Takayasu Arteritis (TA) and its superiority over conventional 7-field FFA in detecting Takayasu retinopathy (TR) changes.Methods: In this prospective observational study, TA patients with Takayasu Retinopathy (TR) who underwent UWF-FFA were enrolled. Standard 7 × 30° ETDRS fields representing conventional imaging were superimposed over the UWF-FFA images. Additional retinal findings captured by UWF-FFA beyond the 7 standard fields were recorded, and their impact on clinical management was noted.Results: Seventy-eight eyes of 39 patients (mean age: 31.31 ± 10 years; 87% female) were included. On UWF-FFA, TR was graded as stage 4 in 5(6.4%) eyes; stage 3 in 33(42.3%), stage 2 in 11(14.1%), stage 1 in 7(9%) eyes, and 22(28.2%) eyes showed no retinopathy. By comparison, conventional imaging detected stage 4 in 4(5.1%) eyes, stage 3 in 1(1.3%), stage 2 in 17(21.8%), stage 1 in 33(42.3%), and 23(29.5%) eyes were normal. UWF-FFA resulted in an increase in detected retinopathy stage in 41 eyes (52.6%, p < 0.05). Notably, UWF-FFA revealed peripheral capillary non-perfusion (CNP) in 28 (35.9%) eyes and neovascularization in 1(1.3%) eye, findings that were missed on conventional fields. These additional findings guided laser photocoagulation treatment in those 28 eyes(35.9%), interventions that would have been missed without UWF imaging.Conclusion: UWF-FFA provided significant additional diagnostic information in over one-half of eyes, enabling detection of advanced retinopathy and guiding timely treatment in 36% of eyes. UWF-FFA should be considered for all patients with TA to improve the detection and management of Takayasu retinopathy.