title: Reevaluating the definition of intraretinal microvascular abnormalities and neovascularization elsewhere in diabetic retinopathy using optical coherence tomography and fluorescein angiography.
abstract: OBJECTIVE
  To evaluate the agreement between clinical examination, spectral-domain ocular coherence tomography (SD OCT), and fluorescein angiography (FA) in diagnosing intraretinal microvascular abnormality (IRMA) and neovascularization elsewhere (NVE) and define the SD OCT features that differentiate NVEs from IRMAs.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Data were collected from 23 lesions from 8 diabetic patients, seen from July 2012 through October 2013 at Moorfields Eye Hospital, United Kingdom. Main outcomes were SD OCT features and FA leakage of IRMA and neovascular complex. The agreement between 3 evaluations was analyzed by Fleiss' kappa.
  
  
  RESULTS
  The following 5 SD OCT features significantly differentiated IRMAs from NVEs: (1) hyperreflective dots in superficial inner retina (P = .002); (2) the outpouching of internal limiting membrane (ILM) (P = .004); (3) the breach of ILM (P = .004); (4) the breach of posterior hyaloid (P = .0005); (5) hyperreflective dots in vitreous (P = .008). The agreement was moderate between 3 evaluations (κ = 0.48, P = 7.11 × 10(-5)) but substantial between clinical and SD OCT evaluation (κ = 0.72, P = .00055). There was no significant agreement between OCT evaluation and FA leakage (κ = 0.249, P = .232).
  
  
  CONCLUSIONS
  SD OCT will be a valuable adjunct in evaluating IRMA and NVE, since it can verify the histopathologic correlate. SD OCT provides subtle anatomic insights and may be more accurate than clinical examination or leakage on FA, our current method of diagnosing this important endpoint, which has implications in future trial design for proliferative diabetic retinopathy prevention.
authors.affiliation: Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Cecilia S
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
authors.forename: Aaron Y
authors.initials: AY
authors.lastname: Lee
authors.affiliation: National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
authors.forename: Dawn A
authors.initials: DA
authors.lastname: Sim
authors.affiliation: Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom.
authors.forename: Pearse A
authors.initials: PA
authors.lastname: Keane
authors.affiliation: Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Hemal
authors.initials: H
authors.lastname: Mehta
authors.affiliation: National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Javier
authors.initials: J
authors.lastname: Zarranz-Ventura
authors.affiliation: University College London, Institute of Ophthalmology, London, United Kingdom.
authors.forename: Marcus
authors.initials: M
authors.lastname: Fruttiger
authors.affiliation: Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Egan
authors.affiliation: Medical Retina Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom; University College London, Institute of Ophthalmology, London, United Kingdom. Electronic address: adnan.tufail@moorfields.nhs.uk.
authors.forename: Adnan
authors.initials: A
authors.lastname: Tufail
mesh_terms: D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology*; D012164:Retinal Diseases / Q000175:diagnosis*; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity