Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
Am J Ophthalmol. 2012 Nov;154(5):908-911.e2. doi: 10.1016/j.ajo.2012.05.019. Epub 2012 Aug 28.
To determine whether the use of ultra wide-field imaging changes the management or determination of disease activity in patients with noninfectious posterior uveitis.
Prospective, observational case series.
setting: Divisions of Retina and Ocular Immunology at single academic medical center. patient population: Total of 43 patients with noninfectious posterior uveitis seen by 4 investigators at the Wilmer Eye Institute. procedures: Each patient underwent standard clinical examination, followed by ultra wide-field scanning laser ophthalmoscope (SLO) imaging and angiography. Investigators successively determined disease activity and management decisions based on clinical examination, examination plus simulated 30- or 60-degree fluorescein angiography (FA) (obtained by physically narrowing the field of view of the wide-field images), examination plus ultra wide-field SLO images, and examination plus wide-field FA. main outcome measures: The primary outcome was the percentage of patients whose management changed based on the availability of wide-field imaging, compared with standard examination and imaging. The secondary outcome was detection of disease activity with and without wide-angle imaging.
Management was altered in 7 of 43 patients (16%) based on examination and limited FA, whereas 21 of 43 patients (48%) had management change with the use of the ultra wide-field imaging and angiography (P < .001). Disease activity was detected in 22 of 43 patients (51%) based on examination and simulated conventional imaging, and in 27 of 43 (63%) with wide-field imaging (P = .27).
The index study, with several design limitations, has suggested that ultra wide-field imaging may alter management decisions compared to standard-of-care imaging and clinical examination. Additional studies, including longitudinal evaluations, are needed to determine whether these findings, or the subsequent management alterations, may improve patient outcomes.
确定超广角成像是否会改变非感染性后部葡萄膜炎患者的疾病活动的管理或判断。
前瞻性、观察性病例系列。
研究地点：威尔默眼科研究所的视网膜和眼免疫科。患者人群：威尔默眼科研究所的 4 位研究者共观察了 43 例非感染性后部葡萄膜炎患者。操作：每位患者均接受标准临床检查，然后进行超广角扫描激光检眼镜（SLO）成像和血管造影。研究者根据临床检查、检查加模拟 30 度或 60 度荧光素血管造影（FA）（通过物理缩小宽视野图像的视野来获得）、检查加超广角 SLO 图像以及检查加宽视野 FA，依次确定疾病活动度和管理决策。主要观察指标：主要结局是根据宽视野成像与标准检查和成像相比，改变管理的患者比例。次要结局是用和不用广角成像检测疾病活动。
基于检查和有限 FA，有 7/43 例（16%）患者的管理发生改变，而 21/43 例（48%）患者在使用超广角成像和血管造影时发生管理改变（P<.001）。基于检查和模拟传统成像，有 22/43 例（51%）患者发现疾病活动，而 27/43 例（63%）患者用广角成像发现疾病活动（P=0.27）。
本研究存在多种设计局限性，提示与标准护理成像和临床检查相比，超广角成像可能改变管理决策。需要进一步开展包括纵向评估在内的研究，以确定这些发现或随后的管理改变是否可以改善患者结局。
