应用非散瞳谱域光相干断层扫描诊断糖尿病性黄斑水肿。
Use of nonmydriatic spectral-domain optical coherence tomography for diagnosing diabetic macular edema.
机构信息
Retinal Unit, Department of Ophthalmology, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
出版信息
Am J Ophthalmol. 2012 Mar;153(3):536-543.e1. doi: 10.1016/j.ajo.2011.08.008. Epub 2011 Oct 11.
PURPOSE
To evaluate the accuracy of 3 spectral-domain (SD) optical coherence tomography (OCT) devices (Topcon 3D-1000 [Topcon]; Cirrus HD [Carl Zeiss Meditec, Inc], and Spectralis OCT [Heidelberg Engineering]) before and after mydriasis for the diagnosis of diabetic macular edema.
DESIGN
Cross-sectional study.
METHODS
Sixty-two eyes of 62 consecutive patients with diabetes without recent loss of vision referred for retinal control were assessed. Two scans were performed for each SD OCT instrument. Central retinal thickness was measured before and after pupil dilation. Pupil dynamic was studied using pMetrics pupillometer (iVIS Technologies), and lens opacity was measured by Pentacam densitometry (Oculus). The diagnostic accuracy of SD OCT devices was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the effect of pupil size and lens opacity on the reliability of SD OCT in the acquisition of adequate images.
RESULTS
The area under the receiver operating characteristic curve for the Topcon 3D OCT device was 0.84, that for the Cirrus HD OCT device was 0.93, and that for the Spectralis OCT device was 0.91. Significant differences in area under the receiver operating characteristic curve before and after pupillary dilatation were not found. Sensitivity and specificity associated with the cutoff value for the best performance were 82% and 74% for the Topcon 3D OCT device, 90% and 87% for the Cirrus HD OCT device, and 90% and 84% for the Spectralis OCT device, respectively. The Topcon 3D OCT device had an 11.3% segmentation algorithm failure rate for the central millimeter of the fovea, and the nuclear lens density was significantly greater in these eyes than in those without failure (17.1 ± 1.1 mm vs 10.4 ± 0.2 mm; P < .05).
CONCLUSIONS
SD OCT is a useful tool to detect and to measure diabetic macular edema without the need for pupil dilatation.
目的
评估 3 种频域（SD）光学相干断层扫描（OCT）设备（Topcon 3D-1000 [Topcon]；Cirrus HD [Carl Zeiss Meditec，Inc]和 Spectralis OCT [海德堡工程公司]）散瞳前后诊断糖尿病性黄斑水肿的准确性。
设计
横断面研究。
方法
对 62 例连续就诊的糖尿病患者（无近期视力丧失）的 62 只眼进行评估。每只眼对 3 种 SD-OCT 仪器进行 2 次扫描。中央视网膜厚度在瞳孔扩张前后进行测量。使用 pMetrics 瞳孔计（iVIS 技术）研究瞳孔动态，使用 Pentacam 密度计（Oculus）测量晶状体混浊度。通过灵敏度、特异性和接收者操作特征曲线下面积评估 SD-OCT 设备的诊断准确性。使用逻辑回归分析评估瞳孔大小和晶状体混浊度对 SD-OCT 采集充分图像的可靠性的影响。
结果
Topcon 3D-OCT 设备的接收者操作特征曲线下面积为 0.84，Cirrus HD-OCT 设备的为 0.93，Spectralis OCT 设备的为 0.91。瞳孔扩张前后，接收者操作特征曲线下面积差异无统计学意义。Topcon 3D-OCT 设备最佳性能的最佳截断值的灵敏度和特异性分别为 82%和 74%，Cirrus HD-OCT 设备为 90%和 87%，Spectralis OCT 设备为 90%和 84%。Topcon 3D-OCT 设备在黄斑中心 1 毫米处的分割算法失败率为 11.3%，这些眼的核晶状体密度明显高于未失败的眼（17.1±1.1mm 比 10.4±0.2mm；P<0.05）。
结论
SD-OCT 是一种无需散瞳即可检测和测量糖尿病性黄斑水肿的有用工具。
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