OCT-A Outperforms Dye Angiography in Detecting Pachychoroid Neovasculopathy

Optical coherence tomography-angiography (OCT-A) demonstrates superiority over dye angiography for detecting pachychoroid neovasculopathy (PNV), according to research published in Photodiagnosis and Photodynamic Therapy. OCT-A can serve as an efficient and noninvasive technique for monitoring PNV, according to the report. 

Between October 2018 and January 2021, researchers recruited 201 patients (eyes, 340; mean [SD] age, 49.8 [9.2] years; 84.6% men) exhibiting the pachychoroid phenotype. All participants underwent a comprehensive ophthalmic examination on the same day. The research team used multimodal imaging as the reference to assess the diagnostic accuracy of fundus fluorescein angiography (FFA), FFA combined with indocyanine green angiography (ICGA) and OCT-A for identifying PNV. 

According to the report, PNV was identified in 58 eyes (46 patients). Patients with PNV were significantly older (54.6 vs 48.2 years), more likely to have a history of chronic central serous chorioretinopathy (CSC;93.1% vs 12.4%), and showed worse visual acuity (0.30 vs 0.58 logarithm of the minimum angle of resolution [logMAR]), compared with patients without PNV (all P <.001).

The sensitivity of FFA, FFA combined with ICGA, and OCT-A in identifying PNV among patients with the pachychoroid phenotype was 67.2%, 63.8% and 98.3%, respectively, and the specificity was 87.2%, 96.8% and 100.0%, respectively. Eyes with PNV that were not detected by dye angiography were characterized by the absence of late plaque hypercyanescence on ICGA (P <.001), smaller capillaries without a distinct pattern (P =.001), less core vessels (P =.002) and a smaller area (P =.044).

“In conclusion, we enrolled patients with a pachychoroid phenotype in this study and revealed that OCTA showed superior detection rate and accuracy for identifying PNV over conventional dye angiography,” according to the researchers. “In case multimodal imaging is unavailable, OCTA can be an effective and noninvasive method for detecting PNV and guiding treatment decisions.”

Study limitations include its cross-sectional nature, an overrepresentation of men in the study population, and selection bias due to the hospital-based design.