VALUE OF COMBINING ULTRA-WIDEFIELD FUNDUS FLUORESCEIN ANGIOGRAPHY WITH 130° SINGLE-SCAN ULTRA-WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN RETINAL VASCULOPATHIES.

Abstract

The evaluation of retinal vasculopathies such as diabetic retinopathy (DR) and retinal vein occlusion (RVO) increasingly benefits from integrating ultra-widefield fluorescein angiography (UWF-FFA) and single-scan ultra-widefield optical coherence tomography angiography (UWF-OCTA). This study aimed to assess the real-life application of retinal angiography and OCTA for detecting retinal neovascularization and peripheral ischemia. Although UWF-FFA remains the only dynamic modality capable of capturing perfusion flow and leakage, OCTA provides noninvasive, high-resolution, depth-resolved vascular imaging without systemic risks. In this real-world study, UWF-FFA performed with the Optos Silverstone was compared with UWF-OCTA obtained using the DREAM OCT platform, capturing up to 130° in a single acquisition and 200° with montage reconstruction. Among 50 enrolled patients-mostly with varying stages of DR, including proliferative disease and previous panretinal photocoagulation (PRP)-the number of neovascularizations identified was comparable across modalities. Profound, meaning well-defined retinal ischemia and visually obvious because of significant image contrast between perfused and nonperfused retinal areas was also comparable, whereas mild and meaning less defined retinal ischemia was more extensive in UWF-FFA because of the larger imaged area. Foveal avascular zone (FAZ) measurements appeared larger on FFA, whereas IRMAs were more frequently identified on UWF-OCTA. Despite its smaller single-scan field, UWF-OCTA provided excellent image quality and high sensitivity to vascular abnormalities, even with media opacities. These findings support the complementary roles of UWF-FFA and UWF-OCTA, emphasizing their combined value in enhancing diagnostic precision, guiding treatment, and monitoring disease progression in retinal vascular disorders.