OCTA as a reliable prognostic tool for active NVD treated with Panretinal Photocoagulation and/or ranibizumab

Purpose: To compare the prognosis of neovascularization of the disc (NVD) after panretinal photocoagulation (PRP) and/or ranibizumab treatment, based on OCT angiography (OCTA) patterns. Methods: In this prospective study, treatment-naive patients with stage IV diabetic retinopathy (DR) and NVD were imaged with 6x6 mm 2 OCTA scans. NVD was classified according to OCTA morphological features: different sources (retinal arteries and veins), different activities (exuberant vascular proliferation (EVP)+ and EVP-) and different configurations (type I&II, III and IV). All patients were treated with PRP or in combination with ranibizumab. Patients were monitored monthly to detect the occurrence of vitreous haemorrhage and/or retinal detachment (VH&RD), as well as changes in best corrected visual acuity (BCVA) and NVD. Results: Among 114 eyes, 35 developed VH&RD (mean onset 6.1 months). Different configurations and EVP status (+/-) significantly affected VH&RD occurrence (p<0.05). NVD regression occurred in 52 eyes, with EVP status significantly influencing resolution (p=0.022). No significant effect was observed on visual acuity (p>0.05). Conclusion: NVD can be classified into different patterns based on morphological features in OCTA, which play a crucial role in the prognosis of NVD patients after PRP and/or ranibizumab treatment.