Retinal macroaneurysms are acquired dilations of retinal arteries, typically occurring in the posterior segment and most commonly in the superotemporal artery. They are classified into three types: quiescent (asymptomatic), hemorrhagic (due to hypertension), and exudative (due to retinal vein occlusions). Detection of macroaneurysms in diabetic retinopathy patients is crucial due to the increased risk of diabetic macular edema around the world. Multimodal imaging, including fluorescein angiography, indocyanine green angiography, and spectral domain optical coherence tomography (SD-OCT), is used for precise characterization and treatment selection.
Conflict of interests : none
A retrospective single-center analysis of SD-OCT, the study was conducted at the ophthalmology department of Pitié-Salpêtrière Hospital, Sorbonne University, between 2022 and 2023, complying with the Declaration of Helsinki. 30 patients (51% males, with mean ± standard deviation of 50,2 ± 14,6) with 60 eyes underwent clinical evaluation through slit-lamp and fundus examination and multi-modal imaging including FA and SD-OCT with infrared imaging (all on HRA Heidelberg Engineering, Germany). Sensitivity, specificity, false positive, and false negative rates were estimated, with joint 90% confidence intervals provided as well as the positive and negative predictive value. The Kappa coefficient of Cohen was used to measure two retinal specialists’ agreement on the diagnosis.
The sensitivity of SD-OCT in detecting retinal macroaneurysms was 87.5%, with a specificity of 25.8%. The positive predictive value (PPV) and negative predictive value (NPV) were 60% and 61%, respectively. In comparison, fluorescein angiography (FA) showed a sensitivity of 31.25% and a specificity of 58.4%. The PPV and NPV for FA were 40.3% and 48.3%, respectively.
SD-OCT was more sensitive than FA in detecting retinal macroaneurysms, suggesting that it could serve as a valuable initial diagnostic tool for early detection during routine consultations. However, indocyanine green angiography remains the gold standard examination for identifying both micro- and macroaneurysms
Further multicenter studies are needed to validate and reinforce these results.
