Joeres Sandra, Kaplowitz Kevin, Brubaker Jacob W, Updike Paul G, Collins Allyson T, Walsh Alexander C, Romano Peggy W, Sadda Srinivas R
Doheny Image Reading Center, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Ophthalmology. 2008 Feb;115(2):347-354.e2. doi: 10.1016/j.ophtha.2007.03.082. Epub 2007 Jul 12.
To demonstrate the benefit of enhanced quantitative analysis of optical coherence tomography (OCT) images using computer-assisted grading to compare the short-term morphologic effects of pegaptanib and bevacizumab treatment for neovascular age-related macular degeneration (AMD).
Retrospective consecutive case series.
Fifty-three cases with neovascular AMD undergoing pegaptanib or bevacizumab therapy.
Fifty-three consecutive cases of patients who underwent StratusOCT imaging followed by treatment with either intravitreal pegaptanib (n = 18) or bevacizumab (n = 35) for neovascular AMD were retrospectively collected. Raw exported StratusOCT images were analyzed using publicly available custom software (OCTOR) designed to define the boundaries of various spaces manually. Changes in thickness and volume of the retina, subretinal fluid (SRF), subretinal tissue, and pigment epithelial detachments (PEDs) before treatment and at 3 months after treatment were calculated and compared between treatment groups. OCTOR software measurements after manual grading were also compared with the automated StratusOCT output.
Volume and thickness measurements calculated by the automated StratusOCT software and the manual grading software OCTOR.
Intravitreal bevacizumab resulted in a statistically significant greater reduction of total retinal volume than pegaptanib (-0.88+/-1.4 mm(3) vs. -0.07+/-0.5 mm(3), P = 0.003). Mean foveal central subfield (FCS) retinal volume decreased from 0.26+/-0.1 mm(3) to 0.21+/-0.1 mm(3) (P = 0.001) in the bevacizumab group and remained constant at 0.22+/-0.1 in the pegaptanib group 3 months after injection. Subanalysis of the SRF, subretinal tissue, and PEDs revealed statistically significant reductions of the total volume of all 3 spaces after bevacizumab injections but no significant change after pegaptanib treatment. Automated StratusOCT output measurements of FCS thickness, foveal center point thickness, and total volume of the retina did not reveal a statistically significant difference between the treatments.
Differences in morphologic response between treatments were less apparent on automated StratusOCT output than on computer-assisted analysis. Although intravitreal bevacizumab was associated with a greater short-term reduction in features of exudation than pegaptanib therapy, the retrospective design of the study limits the significance of this finding. Computer-assisted subanalysis of OCT data, however, may be a useful tool in more precisely defining the anatomic effects of therapies for neovascular AMD.
通过计算机辅助分级增强光学相干断层扫描（OCT）图像的定量分析，以比较培加他尼和贝伐单抗治疗新生血管性年龄相关性黄斑变性（AMD）的短期形态学效果，从而证明其益处。
回顾性连续病例系列。
53例接受培加他尼或贝伐单抗治疗的新生血管性AMD患者。
回顾性收集53例连续的患者，这些患者先进行了StratusOCT成像，随后接受玻璃体内注射培加他尼（n = 18）或贝伐单抗（n = 35）治疗新生血管性AMD。使用公开可用的定制软件（OCTOR）对导出的原始StratusOCT图像进行分析，该软件用于手动定义各个区域的边界。计算并比较治疗组治疗前和治疗后3个月时视网膜、视网膜下液（SRF）、视网膜下组织和色素上皮脱离（PED）的厚度和体积变化。手动分级后的OCTOR软件测量结果也与StratusOCT自动输出结果进行比较。
StratusOCT自动软件和手动分级软件OCTOR计算的体积和厚度测量值。
玻璃体内注射贝伐单抗导致视网膜总体积减少的幅度在统计学上显著大于培加他尼（-0.88±1.4 mm³对-0.07±0.5 mm³，P = 0.003）。贝伐单抗组黄斑中心凹中央子区域（FCS）视网膜体积从0.26±0.1 mm³降至0.21±0.1 mm³（P = 0.001），而培加他尼组在注射后3个月保持在0.22±0.1不变。对SRF、视网膜下组织和PED的亚分析显示，注射贝伐单抗后所有3个区域的总体积均有统计学意义的减少，但培加他尼治疗后无显著变化。StratusOCT自动输出的FCS厚度、黄斑中心点厚度和视网膜总体积测量结果显示，两种治疗方法之间在统计学上无显著差异。
与计算机辅助分析相比，治疗间形态学反应的差异在StratusOCT自动输出结果中不太明显。尽管玻璃体内注射贝伐单抗与比培加他尼治疗在短期内渗出特征减少更多相关，但本研究的回顾性设计限制了这一发现的意义。然而，OCT数据的计算机辅助亚分析可能是更精确界定新生血管性AMD治疗解剖学效果的有用工具。
