Optical coherence tomography angiography aids fluorescein angiography in the confirmation of optic disc neovascularization

A 58-year-old male with known diabetes mellitus and hypertension presented with best corrected visual acuity of 20/100 OU with normal anterior segments. Dilated fundus examination revealed severe non-proliferative diabetic retinopathy and macular edema in both eyes. Fundus fluorescein angiography (FFA) right eye confirmed the findings and, in addition, showed a localized hyperfluorescence at the optic disc which failed to increase in size and intensity in late phases (red arrows, Fig. 1a and b). Although progressive enlargement of hyperfluorescence is a classic feature of neovascularization, early neovascularization may not always show enlargement over time. In particular, small neovascularizations with minimal leakage that lie directly over retinal vessels can be especially difficult to detect on FA.[1] The localized intensity of leakage, which appeared greater than that of adjacent microaneurysms, raised suspicion of new vessel formation despite the absence of temporal progression. Superficial slabs of optical coherence tomography angiography (OCTA) confirmed the presence of new vessels both on en-face (arrow, 1c) and B-scan images (arrow, 1d). The patient was diagnosed with proliferative diabetic retinopathy and began treatment with pan-retinal photocoagulation. These findings underscore the importance of correlating FA and OCTA results as part of a multimodal imaging approach for accurate diagnosis and teaching—while OCTA provides non-invasive flow visualization, careful interpretation of FFA remains indispensable. Integrating the dynamic leakage characteristics observed on FFA with the flow architecture demonstrated on OCTA further enhances diagnostic accuracy.Figure 1: (a and b) Fundus fluorescein angiography OD showed localised hyperfluorescence of disc which failed to increase in size and intensity in late phases. Superficial slabs of OCT angiography confirmed the presence new vessels both on en-face (arrow, c) and B-scan images (arrow, d)Authors’ contributions Concept: Dr Vinod Kumar; Design: Dr Rohan Chawla, Dr Vinod Kumar; Definition of intellectual content: Dr Rohan Chawla, Dr Vinod Kumar; Literature search: Dr Josh Kumar; Clinical studies/data acquisition: Dr Josh Kumar; Data analysis: Dr Adithi K Murthy, Dr Josh Kumar; Statistical analysis: Not applicable; Manuscript preparation: Dr Adithi K Murthy; Manuscript editing: Dr Adithi K Murthy; Manuscript review: All authors. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understands that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.