Detection of diabetic neovascularisation using single-capture 65°-widefield optical coherence tomography angiography.

To assess the detection rate of retinal neovascularisation (NV) in eyes with proliferative diabetic retinopathy (PDR) using widefield optical coherence tomography angiography (WF-OCTA) in comparison to ultrawidefield fluorescein angiography (UWF-FA). Single-capture 65°-WF-OCTA-imaging was performed in patients with NV at the disc or elsewhere (NVE) detected on UWF-FA using a modified PlexElite system and B-scans were examined for blood flow signals breaching the internal limiting membrane. Sensitivity of WF-OCTA and UWF colour fundus (UWF-CF) photography for correct diagnosis of PDR was determined and interdevice agreement (Fleiss' κ) between WF-OCTA and UWF-FA for detection of NV in the total gradable area and each retinal quadrant was evaluated. Fifty-nine eyes of 41 patients with PDR detected on UWF-FA were included. Sensitivity of detecting PDR on WF-OCTA scans was 0.95 in contrast to 0.78 on UWF-CF images. Agreement in detecting NVE between WF-OCTA and UWF-FA was high in the superotemporal (κ=0.98) and inferotemporal (κ=0.94) and weak in the superonasal (κ=0.24) and inferonasal quadrants (κ=0.42). On UWF-FA, 63% of NVEs (n=153) were located in the temporal quadrants with 93% (n=142) of them being detected on WF-OCTA scans. The high reliability of non-invasive WF-OCTA imaging in detecting PDR can improve clinical examination with the potential to replace FA as a single diagnostic tool.

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Competing interests: Research was funded by European Commisson H2020 programme initiated by the Photonics Public Private Partnership (MOON number 732969). UMS-E is a scientific consultant for Genentech, Heidelberg, Kodiak, Novartis, RetinSight, and Roche; and provides contract research for the Medical University of Vienna for Apellis, Genentech and Kodiak. SS is an advisory board member at Bayer, Roche and Novartis. AP is a scientific consultant for Bayer, Roche, Novartis and Oertli Instruments and received financial support by Roche. MN and ThS are consultants for Carl Zeiss Meditec. WD and RL are consultants for and received financial support by Carl Zeiss Meditec. TiS is an employee at Carl Zeiss Meditec Inc. The following athors have no financial disclosures: HS, JI, AS, IS.