SD-OCT and OCTA: distinct or additional information on neovascular activity? The COCTAEYL Study.

Purpose: This study aimed to compare exudative recurrence features detected by optical coherence tomography angiography (OCTA) with those identified by spectral-domain optical coherence tomography (SD-OCT), considered the gold standard, and to characterize OCTA-derived profiles predictive of recurrence in patients with macular neovascularization (MNV) secondary to neovascular age-related macular degeneration (nAMD) treated with aflibercept. Methods: In this prospective observational cohort study, 49 patients were enrolled, yielding data from 686 examinations for concordance analysis between SD-OCT and OCTA. Following a loading phase of three-monthly intravitreal injections of 2 mg Aflibercept, patients were monitored monthly. Both SD-OCT and OCTA were performed at each visit, with intravitreal injections administered bimonthly (fixed regimen) for up to 12 months. Results: OCTA demonstrated a sensitivity of 72%, specificity of 27%, positive predictive value (PPV) of 59%, and negative predictive value (NPV) of 40% for detecting exudative activity. The area under the ROC curve (AUC) for OCTA-defined recurrence was 0.49, with an odds ratio (OR) of 0.95 for predicting neovascular activity in the next month (p=0.87). The net benefit (NB) was 0.13 for OCTA versus 0.19 for a general approach strategy. Relying on OCTA for recurrence detection instead of SD-OCT did not reduce unnecessary intravitreal injections. Conclusion: OCTA and SD-OCT provide complementary information, with OCTA focusing on flow remodeling and SD-OCT highlighting exudative features. OCTA provides complementary vascular flow information to the structural data acquired with SD-OCT, allowing a more comprehensive assessment of neovascular activity, although no modification in management was observed in this cohort.