Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
Invest Ophthalmol Vis Sci. 2013 Apr 23;54(4):2893-901. doi: 10.1167/iovs.12-11085.
To describe novel segmentation protocols for choroidal layers, Sattler's medium and Haller's large vessel layers, using enhanced depth imaging optical coherence tomography (EDI-OCT), and to examine the repeatability and reproducibility of these measurements in eyes with diabetic retinopathy.
Fifty-one patients with Type 2 diabetes mellitus were imaged using custom EDI scanning protocols. Detailed segmentation was performed to quantify the retina, choroid, Haller's large, and Sattler's medium vessel layers in the total macular circle (TMC) and foveal central subfield (FCS). The coefficient of repeatability (CR) and intraclass correlation coefficient (ICC) were used as a measure of repeatability and relative reliability within graders. Reproducibility or interobserver variability was assessed using Bland-Altman plots and 95% limits of agreement (LoA).
Intragrader CR of the retina, choroid, Sattler's, and Haller's layers for thickness measurements were 19.2, 26.9, 35.2, and 29.2 μm, respectively. Intergrader 95% LoA were 27.9, 41.5, 38.6, 31.1 μm (thickness), respectively. Choroidal sublayer measurements showed good intraobserver reliability (ICC 0.78-0.98). Interobserver variability for retinal and choroidal measurements was not significantly different (P > 0.45). Measurements from the TMC showed slightly better repeatability and agreement compared with the FCS alone. Mean intergrader differences were reduced after training, and were most apparent in choroidal sublayers.
The choroidal vascular sublayers can be quantified with good reliability, repeatability, and reproducibility. Accurate quantitative assessment of these sublayers may provide new insights into the role of the choroid in visual loss in patients with diabetic retinopathy, and prove useful for future clinical trials.
描述使用增强深度成像光学相干断层扫描（EDI-OCT）对脉络膜层、Sattler 中层和 Haller 大血管层进行新型分割的方案，并检查这些测量在糖尿病性视网膜病变眼中的可重复性和再现性。
对 51 例 2 型糖尿病患者使用定制的 EDI 扫描方案进行成像。详细分割以定量评估总黄斑环（TMC）和黄斑中心凹小视野（FCS）中的视网膜、脉络膜、Haller 大血管和 Sattler 中层血管。重复性系数（CR）和组内相关系数（ICC）用于衡量分级内的重复性和相对可靠性。使用 Bland-Altman 图和 95%一致性界限（LoA）评估再现性或观察者间变异性。
视网膜、脉络膜、Sattler 层和 Haller 层厚度测量的组内 CR 分别为 19.2、26.9、35.2 和 29.2μm。组间 95%LoA 分别为 27.9、41.5、38.6、31.1μm（厚度）。脉络膜亚层测量具有良好的观察者内可靠性（ICC 0.78-0.98）。视网膜和脉络膜测量的观察者间变异性无显著差异（P＞0.45）。与单独使用 FCS 相比，TMC 的测量结果具有更好的可重复性和一致性。经过培训后，组间差异均值降低，在脉络膜亚层中最为明显。
脉络膜血管亚层可以可靠、重复且可再现地进行量化。这些亚层的准确定量评估可能为脉络膜在糖尿病性视网膜病变患者视力丧失中的作用提供新的见解，并对未来的临床试验有用。
