Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Graefes Arch Clin Exp Ophthalmol. 2020 Sep;258(9):1901-1909. doi: 10.1007/s00417-020-04773-x. Epub 2020 May 30.
To compare the ability of wide-field optical coherence tomography angiography (WF-OCTA) to that of ultra-wide field fluorescein angiography (UWF-FA) and ultra-wide-field color fundus photography (UWF-CP) to detect retinal neovascularization (NV) in eyes with proliferative diabetic retinopathy (PDR).
In this cross-sectional study, naïve patients with active PDR underwent UWF-FA and UWF-CP using the Optos 200Tx and WF-OCTA with 12 × 12 mm fields of five visual fixations using the PLEX Elite 9000. NV was defined on OCTA when the co-registered B-scan with flow overlay of the vitreoretinal interface (VRI) segmentation showed extraretinal proliferation. Three masked readers examined the UWF-FA, UWF-CP, and WF-OCTA independently for the presence of NV. Statistical analysis was performed to compare the diagnostic accuracy of the 3 wide-field imaging modalities using OCT B-scan as the reference standard.
In 82 eyes with PDR, neovascularization of the disc (NVD) was detected in 13 eyes by UWF-CP, 35 eyes with UWF-FA, and 37 eyes with OCTA using the VRI slab. Upon review of the 2500 OCT B-scans with superimposed flow overlay of each eye, NVD was confirmed in 37 eyes. The sensitivity and specificity of NVD detection were 35.1% and 97.8%, respectively for UWF-CP; 94.6% and 100%, respectively, for UWF-FA; and 100% and 100% for WF-OCTA. One hundred ninety-six foci of neovascularization elsewhere (NVE) were identified with the OCT B-scan with superimposed flow overlay. UWF-CP analysis was able to detect 62 foci of NVE of the 196 confirmed by B-scan (31.6% detection rate). An additional 11 foci of NVE seen on UWF-CP were not confirmed by B-Scan (15% false positive rate). There were 182 foci of NVE identified by UWF-FA (detection rate 91.3%), while WF-OCTA detected 196 retinal NVEs (detection rate 100%). The rate of false positives for both UWF-FA and WF-OCTA was low (< 2%).
WF-OCTA can identify NV that is not evident in UWF-CP and represents a faster and safer alternative to UWF-FA for surveillance of PDR with comparable diagnostic accuracy.
比较宽视野光相干断层扫描血管造影术（WF-OCTA）与超广角荧光素血管造影术（UWF-FA）和超广角彩色眼底照相术（UWF-CP）检测增生性糖尿病视网膜病变（PDR）患者视网膜新生血管（NV）的能力。
本横断面研究纳入了未经治疗的 PDR 活动期患者，使用 Optos 200Tx 进行 UWF-FA 和 UWF-CP 检查，使用 PLEX Elite 9000 进行 12×12mm 五个注视点的 WF-OCTA。当 Vitreoretinal 界面（VRI）分段的 co-registered B-scan 与血流叠加显示视网膜外增生时，在 OCTA 上定义 NV。三位盲法读者分别独立检查 UWF-FA、UWF-CP 和 WF-OCTA 以确定 NV 的存在。使用 OCT B 扫描作为参考标准，对 3 种宽视野成像方式的诊断准确性进行了统计分析。
在 82 只 PDR 眼中，UWF-CP 检测到 13 只眼的视盘新生血管（NVD），UWF-FA 检测到 35 只眼，OCTA 使用 VRI 切片检测到 37 只眼。在检查了每只眼的 2500 张叠加了血流的 OCT B 扫描后，在 37 只眼中确认了 NVD。UWF-CP 的 NVD 检测灵敏度和特异性分别为 35.1%和 97.8%；UWF-FA 分别为 94.6%和 100%；WF-OCTA 分别为 100%和 100%。使用 OCT B 扫描叠加血流共发现 196 个其他部位的新生血管化病灶（NVE）。UWF-CP 分析能够检测到 196 个经 B 扫描确认的 NVE 中的 62 个（检测率 31.6%）。UWF-CP 还发现了 11 个未被 B 扫描确认的 NVE（假阳性率 15%）。UWF-FA 发现了 182 个 NVE（检测率 91.3%），而 WF-OCTA 检测到了 196 个视网膜 NVEs（检测率 100%）。UWF-FA 和 WF-OCTA 的假阳性率均较低（<2%）。
WF-OCTA 可以识别 UWF-CP 中不明显的 NV，代表了一种比 UWF-FA 更快、更安全的 PDR 监测替代方法，具有相当的诊断准确性。
