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Optical Coherence Tomography Angiography Features and Flow-Based Classification of Retinal Artery Macroaneurysms.

Mohamed Oshallah1, Anastasios E Sepetis1, Antonio Valastro2

  • 1Ophthalmology Department, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK.

Journal of Clinical Medicine
|December 30, 2025
PubMed
Summary

Optical Coherence Tomography Angiography (OCTA) effectively classifies retinal artery macroaneurysms (RAMs) by flow signal, comparable to traditional fundus fluorescein angiography (FFA). This OCTA-based classification aids in prognosis and treatment decisions for RAMs.

Keywords:
FFAOCTAangiographymacroaneurysm

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Retinal Vascular Diseases

Background:

  • Retinal artery macroaneurysms (RAMs) are vascular abnormalities requiring accurate diagnostic methods.
  • Fundus fluorescein angiography (FFA) is a standard imaging technique for RAMs, but involves systemic injection.
  • Optical Coherence Tomography Angiography (OCTA) offers a non-invasive alternative for visualizing retinal vasculature.

Purpose of the Study:

  • To propose and evaluate a flow-signal-based classification system for RAMs using OCTA.
  • To compare the diagnostic performance of OCTA with FFA in assessing RAM flow profiles.
  • To determine the clinical utility of OCTA in managing RAMs.

Main Methods:

  • Retrospective review of 49 RAM cases (30 eyes) over 6 years.
  • Analysis of OCTA (en face and B-scan) and FFA images for RAM pathology and flow.
  • Classification of RAMs into high, low, and absent flow signal types based on OCTA findings.
  • Direct comparison of OCTA flow profiles with FFA findings in a subgroup of patients.

Main Results:

  • OCTA successfully classified RAMs into three flow signal types: high (9 eyes), low (10 eyes), and absent (9 eyes).
  • FFA findings were comparable to OCTA, showing high (4 eyes), low (6 eyes), and absent (2 eyes) flow.
  • A strong correlation (Spearman's r = 0.79, p = 0.004) was observed between OCTA and FFA flow assessments.
  • One discrepancy noted where FFA showed flow, but OCTA did not, highlighting potential differences.

Conclusions:

  • OCTA provides a reliable and non-invasive method for classifying RAMs based on flow signals.
  • OCTA findings are directly comparable to those of FFA, offering a safer alternative.
  • The proposed OCTA-based classification may improve RAM prognosis, treatment guidance, and follow-up strategies.