ArticleGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie2026
SD-OCT vs FA in diabetic retinopathy: a sensitivity-specificity tradeoff in detecting intraretinal macroaneurysms.
Article in Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate and compare the sensitivity and specificity of spectral-domain optical coherence tomography (SD-OCT) versus fluorescein angiography (FA) in detecting intraretinal macroaneurysms (IMAs) in patients with diabetic retinopathy (DR) in real-life clinical practice.
methodsA retrospective, single-center study was conducted at the ophthalmology department of Pitié-Salpêtrière Hospital, Sorbonne University, from 2019 to September 2022. Fifty-eight eyes from 29 DR patients (mean age 50.2 ± 14.6 years) underwent comprehensive ophthalmological evaluation including slit-lamp examination, MultiColor confocal fundus imaging, and multimodal imaging with FA and SD-OCT (Heidelberg Spectralis HRA + OCT). IMAs were defined as aneurysmal dilations ≥ 150 μm. Because no independent gold standard (e.g., histology) was available, the consensus interpretation across both modalities served as the reference standard, and the resulting incorporation dependency is acknowledged as a limitation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals (CIs) were calculated for each modality, with McNemar's test comparing sensitivities. Cohen's kappa assessed inter-reader agreement.
resultsSD-OCT demonstrated significantly higher sensitivity (92.3%; 95% CI: 79.1-98.4) than FA (48.7%; 95% CI: 32.4-65.2) for IMA detection (p < 0.05). Conversely, FA exhibited higher specificity (63.2%; 95% CI: 38.4-83.7) than SD-OCT (47.4%; 95% CI: 24.4-71.1). The PPV and NPV were 78.3% and 75.0% for SD-OCT, and 73.1% and 37.5% for FA. Inter-reader agreement was moderate to substantial (κ = 0.69 for SD-OCT; κ = 0.51 for FA).
conclusionIn this cohort, SD-OCT showed superior sensitivity but lower specificity than FA for detecting IMAs in patients with DR. This suggests SD-OCT is highly effective for identifying potential IMAs based on structural characteristics, while FA remains valuable for confirming activity based on leakage. The non-invasive nature and high detection rate of SD-OCT support its role as a primary tool in the routine diagnostic workflow for IMAs in DR. Further prospective, multi-center studies are warranted.
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