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  • Use of Widefield OCTA in Proliferative DR

    By Lynda Seminara
    Selected By: Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Graefe’s Archive for Clinical and Experimental Ophthalmology
    2020;258(9):1901-1909

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    Pichi et al. compared the ability of widefield optical coherence tomogra­phy angiography (WF-OCTA), ultra-widefield fluorescein angiography (UWF-FA), and ultra-widefield color fundus photography (UWF-CP) to detect retinal neovascularization in eyes with proliferative diabetic retinopathy (PDR). They found that WF-OCTA was superior to UWF-CP and noninferior to UWF-FA.

    For this cross-sectional study, the authors evaluated treatment-naive patients with active PDR. All patients were imaged with the three widefield modalities. Retina specialists examined the imaging results for neovasculariza­tion, which was defined on OCTA as extra-retinal proliferation of vessels in the vitreoretinal interface slab and was subcategorized by location as neovas­cularization “of the disc” (NVD) or “elsewhere” (NVE). Statistical analysis was performed to estimate the diag­nostic accuracy of each modality, and B-scan OCT with flow overlay was applied as the reference standard.

    Overall, 82 eyes (48 patients) were evaluated. NVD was detected in 13 eyes by UWF-CP, in 35 eyes by UWF-FA, and in 37 eyes by WF-OCTA. NVD was confirmed in the same 37 eyes by the reference standard, indicating 100% sensitivity and 100% specificity for WF-OCTA, 94.6% sensitivity and 100% specificity for UWF-FA, and 35.1% sensitivity and 97.8% specificity for UWF-CP. For NVE, 196 foci in 62 of the 82 eyes were identified by the reference standard. UWF-CP enabled detection of 62 of these foci and mis­classified 11 others, corresponding to a detection rate of 31.6% and a false-pos­itive rate of 15.1%. The detection rate for UWF-FA was 91.3%. WF-OCTA identified all 196 foci (100% detection rate). False-positive rates for UWF-FA and WF-OCTA were below 2%.

    Although FA is the gold standard for detecting subtle signs of neovas­cularization in PDR, it is invasive and is accompanied by safety concerns. WF-OCTA is safer and faster, said the authors, and the diagnostic accuracy in their hands was similar to that of UWF-FA (and significantly better than that of UWF-CP). They concluded that WF-OCTA may have clinical utility for routine monitoring of PDR.

    The original article can be found here.