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. 2025 Sep;14(9):2243-2251.
doi: 10.1007/s40123-025-01213-z. Epub 2025 Jul 24.

Assessment of Relationship between Neovascularization Type Using Wide Field Optical Coherence Tomography Angiography in Eyes with Proliferative Diabetic Retinopathy

Akshita Aggarwal  1   2 , Dibya Prabha  1   2 , Brijesh Takkar  1   3 , Sobha Sivaprasad  4   5 , Padmaja Kumari Rani  6
Affiliations

Assessment of Relationship between Neovascularization Type Using Wide Field Optical Coherence Tomography Angiography in Eyes with Proliferative Diabetic Retinopathy

Akshita Aggarwal et al. Ophthalmol Ther. 2025 Sep.

Abstract

Introduction: Retinal neovascularization in proliferative diabetic retinopathy (PDR) presents with varying morphology and clinical implications. This study aims to classify retinal neovascularization into subtypes and assess their correlation with ischemic index using widefield optical coherence tomography (OCT) angiography.

Methods: This retrospective observational study included 50 treatment-naïve patients (84 eyes) with PDR who underwent baseline widefield fundus photography (CLARUS 500™) and widefield optical coherence tomography angiography (WF-OCTA; Plex Elite 9000) between January 2022 and June 2024. Quantitative analysis of WF-OCTA images assessed capillary nonperfusion (CNP), ischemic index (ISI), and three neovascularization (NV) subtypes: type 1 NV (flat, intraretinal or subinternal limiting membrane growth), type 2 NV (preretinal proliferation extending into the vitreous), and type 3 NV (a combination of types 1 and 2 features, showing both flat and protruding components). Two clinicians manually delineated capillary nonperfusion (CNP) using ImageJ software. Neovascularization (NV) was classified by subtype and location (posterior versus mid-periphery). Ischemic index (ISI), nonperfusion area, best corrected visual acuity (BCVA), and the need for adjunctive interventions (additional laser or vitreoretinal surgery) were correlated with treatment response to panretinal photocoagulation (PRP).

Results: Type 1 neovascularization was most frequent (42.1%), with a mean ischemic index (ISI) of 0.19 ± 0.17. Type 3 neovascularization showed the highest ISI (0.27 ± 0.07) and largest nonperfusion area (36.66 mm2 ± 10.24). Best corrected visual acuity (BCVA) improved in 58% of patients after panretinal photocoagulation, with type 3 showing the greatest improvement. Adjunct laser therapy was required more frequently for type 2 (13 cases) following standard panretinal photocoagulation. However, type 3 required the least supplemental laser.

Conclusions: WF-OCTA proves valuable in the assessment of disease severity and its extent, along with possible implications on planning the intervention for PDR.

Keywords: Diabetic retinopathy; Ischemic index; Neovascularization; Optical coherence tomography angiography; Proliferative diabetic retinopathy.

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Conflict of interest statement

Declarations. Conflict of Interest: Akshita Aggarwal, Dibya Prabha, Brijesh Takkar, Sobha Sivaprasad and Padmaja Kumari Rani have nothing to disclose. Ethical Approval: Ethical approval was obtained from LV Prasad Eye Institute Ethics Committee following the principles of the Declaration of Helsinki (IRB no.: LEC-BHR-R-030). As this was a retrospective study, patient consent for comprehensive examination conducted at the LVPEI network was considered as the study consent.

Figures

Fig. 1
Fig. 1
A Type 1 originating from venous side appears in a tree-like shape (yellow arrow). B Type 2 from capillary networks, has an octopus-like appearance (arrow head). C Type 3 has a sea-fan shape originating from the intraretinal microvascular abnormalities (IRMAs) (yellow circle)
See this image and copyright information in PMC

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