Yannuzzi et al. report on their study aiming to evaluate the ability of optical coherence tomography angiography (OCTA) to differentiate vascularised from nonvascularised pigment epithelium detachments (PEDs) using conventional imaging techniques, including fundus fluorescein angiography (FFA) and indocyanine green (ICG), as the gold standard. This was a single-centre, retrospective, cross-sectional, consecutive case series of eyes with PED. A total of 64 eyes were included in the study. Using the gold standard, 18 eyes were deemed to have nonvascularised PEDs and 46 were deemed to have vascularised PEDs. For the detection of vascularised PEDs, OCTA demonstrated a sensitivity of 76% and a specificity of 61%, with a positive predictive value of 83% and a negative predictive value of 50%. Using only cross-sectional OCTA for the detection of vascularised PED showed that the sensitivity increased from 76% to 98% with the specificity remaining at 61%. OCTA encountered 39% mismatched diagnosis in the nonvascularised PEDs. The most common reason for mismatched diagnosis in nonvascularised PEDs was projection artefact. Of the 46 eyes with vascularised PEDs, 11 eyes (24%) had a false negative result. Ten eyes demonstrated abnormal flow on cross-sectional OCTA but did not demonstrate a vascular complex on en-face OCTA. The rate of mismatched diagnosis was greater in eyes manifesting RPE tears and exudation. The high positive predictive value of OCTA (83%) suggests that when abnormal flow is detected on cross-sectional OCTA and en face OCTA in eyes that also demonstrate active exudation on structural OCT, the diagnosis of an active vascularised PED may be made without the need for fluorescein angiography or ICG.

Imaging of pigment epithelial detachments with optical coherence tomography angiography.
Tan ACS, Freund KB, Balaratnasingam C, et al.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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