En Face Optical Coherence Tomography Imaging as a Structural Surrogate for Posterior Pole Inflammatory Retinal Vascular Activity.

Abstract

To evaluate whether structural en face optical coherence tomography (OCT) can detect structural surrogates at the posterior pole associated with fluorescein angiography (FA)-defined inflammatory retinal vascular activity in uveitis. Prospective, single-center reliability and validity analysis. Twenty-four eyes from 12 patients with uveitis who underwent same-day ultra-widefield FA and macula-centered 12 × 12-mm spectral-domain OCT imaging. FA-defined inflammatory retinal vascular activity was defined as vascular leakage and/or vascular wall staining on late-phase FA in the presence of intraocular inflammation. Structural en face OCT images were generated using a customized slab extending from 35 µm below the inner plexiform layer to 35 µm below the outer plexiform layer, corresponding to the outer plexiform layer-outer nuclear layer transition. Images were graded independently by 2 masked retinal specialists and compared with FA findings on an image-by-image basis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, and intergrader agreement (Cohen's κ). Fifty-three images were analyzed, of which 32 demonstrated FA-defined activity. En face OCT showed a sensitivity of 0.94 (95% CI, 0.83-1.00), specificity of 0.38 (95% CI, 0.10-0.72), PPV of 0.70 (95% CI, 0.45-0.90), NPV of 0.80 (95% CI, 0.50-1.00), and an F1 score of 0.80. Intergrader agreement was moderate (κ = 0.65). Structural en face OCT demonstrated high sensitivity for detecting structural changes associated with FA-defined inflammatory vascular activity at the posterior pole, although specificity was limited. These findings support its potential role as a noninvasive adjunctive tool for identifying regions that may warrant further evaluation, rather than a standalone indicator of active disease.