Value of Combining Ultra-widefield Fundus Fluorescein Angiography (UWF-FFA) with 130° Single-scan Ultra-widefield Optical Coherence Tomography Angiography (UWF-OCTA) in Retinal Vasculopathies.

Purpose: 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. Methods: While UWF-FFA remains the only dynamic modality capable of capturing perfusion flow and leakage, OCTA provides non-invasive, 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. Results: Among 50 enrolled patients—mostly with varying stages of DR, including proliferative disease and prior pan-retinal photocoagulation (PRP)—the number of neovascularizations identified was comparable across modalities. Profound, meaning well-defined retinal ischemia and visually obvious due to significant image contrast between perfused and non-perfused retinal areas was also comparable, whilst mild and meaning less defined retinal ischemia was more extensive in UWF-FFA due to 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. Conclusion: 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.