Henschel Andreas, Spital Georg, Lommatzsch Albrecht, Pauleikhoff Daniel
Department of Ophthalmology, St. Franziskus-Hospital, Muenster - Germany.
Eur J Ophthalmol. 2009 Sep-Oct;19(5):831-5. doi: 10.1177/112067210901900523.
To assess the sensitivity and specificity of optical coherence tomography (OCT) for monitoring patients with choroidal neovascularization (CNV) after photodynamic therapy (PDT) in comparison to fluorescein angiography (FA).
Prospective study of 14 patients with CNV secondary to age-related macular degeneration receiving PDT. Best-corrected visual acuity (BCVA), fluorescein angiography, and OCT (Zeiss Stratus OCT3) were performed before and at 2, 6, 12, and 24 weeks after treatment. FA images were assessed for leakage and presence of subretinal or intraretinal fluid was assessed on OCT images. Retinal thickness was measured automatically. OCT sensitivity and specificity levels for detecting leaking CNV were calculated. Retinal thickness was correlated with visual acuity.
Mean follow-up time was 14.1 weeks. Sixty-one OCT/FA examinations were analyzed. Thirty-one examinations presented leakage (51%). OCT showed intraretinal fluid in 46 (75%) and subretinal fluid in 30 cases (49%). In 49 cases (80%), either intraretinal or subretinal fluid was present. Sensitivity for detecting intraretinal fluid in OCT was 90% (specificity 40%) and 71% (specificity 73%) for subretinal fluid. Combined sensitivity for intraretinal or subretinal fluid was 97% (specificity 37%). Increased central foveal thickness correlated with decreased BCVA. Correlations were significant (p<0.05).
OCT showed good sensitivity in detecting active CNV. Specificity was only moderate. Central foveal thickness correlated negatively with visual acuity. Owing to different aspects of active CNV shown by FA and OCT, OCT should be combined with other examinations, and may not substitute FA for indication/reindication of PDT but can be a valuable addition in difficult cases.
与荧光素血管造影（FA）相比，评估光学相干断层扫描（OCT）监测光动力疗法（PDT）后脉络膜新生血管（CNV）患者的敏感性和特异性。
对14例年龄相关性黄斑变性继发CNV并接受PDT治疗的患者进行前瞻性研究。在治疗前以及治疗后2、6、12和24周进行最佳矫正视力（BCVA）、荧光素血管造影和OCT（蔡司Stratus OCT3）检查。评估FA图像有无渗漏，在OCT图像上评估视网膜下或视网膜内液的存在情况。自动测量视网膜厚度。计算OCT检测渗漏性CNV的敏感性和特异性水平。将视网膜厚度与视力进行相关性分析。
平均随访时间为14.1周。分析了61次OCT/FA检查。31次检查出现渗漏（51%）。OCT显示46例（75%）有视网膜内液，30例（49%）有视网膜下液。49例（80%）存在视网膜内或视网膜下液。OCT检测视网膜内液的敏感性为90%（特异性为40%），检测视网膜下液的敏感性为71%（特异性为73%）。视网膜内或视网膜下液的联合敏感性为97%（特异性为37%）。中心凹厚度增加与BCVA下降相关。相关性具有统计学意义（p<0.05）。
OCT在检测活动性CNV方面显示出良好的敏感性。特异性仅为中等。中心凹厚度与视力呈负相关。由于FA和OCT显示的活动性CNV的不同方面，OCT应与其他检查相结合，在PDT的指征/再指征方面可能不能替代FA，但在疑难病例中可能是有价值的补充。
