Validity of Spectral-Domain Optical Coherence Tomography Angiography for Detection of Retinal Vasculitis

Background and Objective: The aim of this study was to evaluate the validity and accuracy of spectral-domain optical coherence tomography angiography (SD-OCTA) in detecting small-vessel retinal vasculitis (RV) at the posterior pole. Patients and Methods: In this prospective study, subjects with and without retinal vasculitis on fundus fluorescein angiography (FFA) were identified among the clinic population and imaged with 8 × 8-mm SDOCTA scans centered on the fovea. Retinal vasculitis was detected using a customized method based on increased perivascular retinal thickness on OCTA. Three reviewers evaluated the FFA and composite en-face scans on SD-OCTA. The method's accuracy was assessed by obtaining sensitivity, specificity, negative predictive value, and positive predictive values, together with 95% confidence intervals, where the gold standard was the consensus FFA result. Results: Eighteen eyes without RV and 34 eyes with RV were selected for evaluation. The consensus sensitivity and specificity were 88.2% ( P < .0001) and 77.7% ( P = .0184), respectively. Several distinct patterns were recognized on OCTA scans based on retina vessel staining, leakage, cystoid macular edema, and ischemia. Conclusions SD-OCTA is a valid and accurate noninvasive imaging tool that detects small-vessel RV at the posterior pole using customized scans across a wide range of RV etiologies. Future studies combining wide-field images and en-face scans may demonstrate OCTA's usefulness in detecting and monitoring retinal vasculitis.