Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
Am J Ophthalmol. 2011 Dec;152(6):1044-1052.e5. doi: 10.1016/j.ajo.2011.05.028. Epub 2011 Sep 8.
To identify a clinically meaningful threshold for change in retinal thickness measured by optical coherence tomography for patients with uveitic macular edema using correlation with change in visual acuity.
Cross-sectional and longitudinal study.
One hundred twenty-eight eyes (101 individuals) with macular edema enrolled in the Multicenter Uveitis Steroid Treatment (MUST) trial. At enrollment and after 6 months of follow-up, retinal thickness was measured at the central subfield with time-domain optical coherence tomography and visual acuity was measured with logarithmic (Early Treatment Diabetic Retinopathy Study) visual acuity charts. Participants were classified as having macular edema if the retinal thickness was 260 μm or more.
A threshold for change in retinal center subfield thickness of 20% balanced the percentage of false positives and false negatives for predicting more than a 10-letter change in visual acuity with a sensitivity of 77% and a specificity of 75%. The results were similar for more than 5-letter changes and for 15-letter or more changes. Those with a 20% or more reduction in retinal thickness had a mean 11.0-letter improvement (95% confidence interval, 7.7 to 14.3) as compared with a -0.4-letter change (95% confidence interval, -4.1 to 3.3) in visual acuity for those without a 20% reduction (P < .01).
In addition to being above the level of measurement uncertainty, a 20% change in retinal thickness in patients with macular edema seems to be optimal for clinically important changes in visual acuity and may be considered as an outcome for clinical trials of treatments for uveitic macular edema.
通过与视力变化的相关性，确定光相干断层扫描测量的葡萄膜炎性黄斑水肿患者视网膜厚度变化的临床有意义的阈值。
横断面和纵向研究。
101 例（128 只眼）黄斑水肿患者纳入多中心葡萄膜炎激素治疗（MUST）试验。在入组时和 6 个月随访时，使用时域光相干断层扫描仪测量中央子场视网膜厚度，使用对数（早期糖尿病视网膜病变治疗研究）视力表测量视力。如果视网膜厚度为 260 μm 或以上，则将患者归类为患有黄斑水肿。
视网膜中心子场厚度变化 20%的阈值可以平衡预测视力变化超过 10 个字母的假阳性和假阴性的百分比，其敏感性为 77%，特异性为 75%。对于视力变化超过 5 个字母和 15 个字母或更多的情况，结果相似。与视网膜厚度减少 20%或更多的患者相比，视网膜厚度减少 20%的患者平均视力提高 11.0 个字母（95%置信区间，7.7 至 14.3），而视网膜厚度无减少 20%的患者视力变化为 -0.4 个字母（95%置信区间，-4.1 至 3.3）（P <.01）。
除了高于测量不确定度水平外，黄斑水肿患者视网膜厚度变化 20%似乎与视力的临床重要变化最相关，可被视为葡萄膜炎性黄斑水肿治疗临床试验的结果。
