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The purpose was to assess the level of agreement and reproducibility between fluorescein angiography (FA) and optical coherence tomography angiography (OCTA), throughout the evaluation of the foveal avascular zone (FAZ) to diagnose diabetic macular ischemia (DMI). Methods: In this ambispective, observational, cross-sectional research, 52 eyes underwent traditional FA and OCTA to obtain the level of agreement and reproducibility between them, using an intraclass correlation coefficient (ICC) in mixed models; for this purpose, two raters independently graded the area of the FAZ using the OCTA Spectralis and the ImageJ software. Additionally, Spearman and rank-biserial correlational analyses were also realized to calculate the strength of linear relationship between the area of the retinal vessels, the thickness of subfoveal retinal and choroid layers, the presence of neovascularization, the visual acuity, and the grade of diabetic retinopathy using the grades of the Early Treatment Diabetic Retinopathy Study protocols. Result: From the evaluated eyes, the level of agreement between the OCTA and FA among the raters had an ICC of 0.99 and 0.907 (p<.001), respectively. Furthermore, the reproducibility analysis had an ICC of 0.85 (p<.001). In the correlation analyses, the enlargement of the FAZ was associated with a decrease in the outer retinal layers (r=-0.458, p<0.001), the photoreceptor layer (r=-0.32, p=0.021), their outer segments (r=-0.32, p=0.021) and the subfoveal choroidal thickness (r=-0.483, p<0.001). A reduction of the vascular area was also observed in higher grades of diabetic retinopathy (r= 0.395, p=0.38). Conclusion: Compelling evidence of a high level of agreement and reproducibility between OCTA and FA was obtained to diagnose diabetic macular ischemia. Moreover, it is suggested that the increase in macular ischemia leads to the thinning of the photoreceptor, outer retinal and choroid layers.

ijretina (international journal of retina)

Quantification of diabetic macular ischemia: Assessing agreement and reproducibility between Optical coherence tomography angiography and Fluorescein angiography