Bimodal imaging of proliferative diabetic retinopathy vascular features using swept source optical coherence tomography angiography

AIM: To categorize neovessels morphology and to detect response to anti-angiogenic therapy by using structural and angiographic modes of swept source optical coherence tomography (SS-OCT). METHODS: Thirty-two eyes with neovessels at disc (NVD) and neovessels elsewhere (NVE) - as diagnosed by fluorescein angiography-were included. Cross sectional OCT images of disc and macular regions were registered to enface OCT angiography (OCTA), B-scan blood flow over lay and density maps. Three eyes received antiangiogenic treatment. RESULTS: Pin point registration of cross-sectional OCT and OCTA images differentiated active NVD with vascular elements from fibrous or equivalent fibrovascular elements. En face images delineated NVE as vascular tufts or area of filling while cross-sectional images differentiated NVE from microvascular intraretinal abnormality (IRMA). All cases were associated with enlargement of foveal avascular zone and or areas of capillary non perfusion. Regressed NVD appeared as ghost vessel or pruned vascular loops after injection. CONCLUSION: Structural and angiographic modes of SS-OCT can detect, characterize and categorize the pattern of wide spectrum of neovessels based on blood flow data and density maps. It is potentially useful to detect ischemic changes in the vascular bed and regression of NVD after therapeutic regimens providing substitute for invasive techniques.