Efficacy of En Face Optical Coherence Tomography Minimum Intensity Projection in Evaluating Inflammatory Retinal Vascular Changes.

PURPOSE: To evaluate the diagnostic performance of en face optical coherence tomography (OCT) using minimum intensity projection (MIP) to detect fluorescein angiography (FA)-defined inflammatory retinal vascular changes.

DESIGN

Prospective, single-center reliability and validity analysis.

PARTICIPANTS

A total of 318 eyes from 177 patients with uveitis who underwent same-day ultra-widefield FA and macula-centered 12 × 12-mm spectral-domain OCT imaging.

METHODS

Inflammatory retinal vascular changes were defined as vascular leakage and/or vascular wall staining on late-phase FA. En face OCT images were generated using MIP slabs spanning 10% to 70% of total retinal thickness. MIP images and retinal thickness maps were independently graded in a masked fashion and compared with FA as the reference standard. Diagnostic performance metrics were calculated. Inter-grader agreement was assessed using Cohen's κ coefficient.

MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, and inter-grader agreement for detecting FA-defined inflammatory retinal vascular changes.

RESULTS

FA demonstrated inflammatory retinal vascular changes in 208 of 318 eyes (65%), including 94 with activity within the central 12 × 12-mm field and 114 with activity confined to the peripheral retina. Overall, MIP en face OCT achieved a sensitivity of 0.82, specificity of 0.55, PPV of 0.77, NPV of 0.62, and F1 score of 0.80 for detecting FA-defined inflammatory retinal vascular changes. Compared with retinal thickness maps, MIP demonstrated substantially higher sensitivity (0.82 vs 0.50) and F1 score (0.80 vs 0.57). MIP en face OCT identified FA-positive eyes with higher detection rates than retinal thickness maps for both central activity (98% vs 60%) and peripheral-only activity (68% vs 42%). Inter-grader agreement was higher for MIP images (κ = 0.75) than for thickness maps (κ = 0.37). In a subset of eyes with longitudinal follow-up, MIP positivity preceded or persisted beyond changes in FA leakage.

CONCLUSIONS

En face OCT using MIP demonstrated high sensitivity for detecting FA-defined inflammatory retinal vascular changes. Although not a replacement for FA, this approach may provide a noninvasive adjunct for clinical assessment and longitudinal evaluation of uveitic disease.