Foveal neovascularization on optical coherence tomography angiography

Abstract

Neovascularization is a hallmark of proliferative diabetic retinopathy (PDR) and is mostly seen at the disc or around major vascular arcades. Neovascularization at fovea (NVF) does not usually occur because of its dense vascular supply by the choriocapillaris beneath the macula which yields high oxygen concentration to the fovea. However, the decreased choroidal blood flow and choroidal vessel density in diabetics[1] is presumed to be responsible for NVF along with perifoveal retinal ischemia.[2] We report an image of unilateral NVF with vitreomacular traction [Figure 1]. Optical coherence tomography angiography (OCTA) being a non-invasive and dye-less imaging modality helps in identifying subtle NVF which may be missed due to the leakage of the dye in FFA.Figure 1: Macular optical coherence tomography angiography (OCTA) showing (a) altered foveal avascular zone with irregular vessels arising from perifoveal capillaries in superficial capillary plexus (yellow circle). (b) No new vessels in deep capillary plexus. (c) Vascular density and flow index map indicating low blood flow in perifoveal area with high blood flow in neovascular lesion (red circle). (d) Structural OCT shows homogenous moderate reflective lesion with flow signal arising from superficial retina and being pulled by the vitreomacular tractionStatement of informed consent Informed consent was obtained prior to performing the procedure, including permission for publication of all photographs and images included herein. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.