Johns Hopkins University School of Medicine, Baltimore, Maryland.
Invest Ophthalmol Vis Sci. 2014 Mar 6;55(3):1370-7. doi: 10.1167/iovs.13-13049.
Some clinical trials that proved the benefits of anti-VEGF therapy for diabetic macular edema (DME) based retreatment decisions on visual acuity and time-domain ocular coherence tomography (TD-OCT) central subfield thickness changes since the last treatment. This study assessed the impact of TD-OCT followed by spectral domain (SD)-OCT on as needed treatment decision-making in the management of DME with anti-VEGF medications.
Patients previously treated for DME with anti-VEGF medications in the Retina Division of the Wilmer Eye Institute, following an institutional review board-approved informed consent process, underwent clinical examination, TD-, and SD-OCT imaging. Their retina specialists recorded whether additional anti-VEGF therapy was recommended and their level of certainty in the decision after performing a clinical examination and reviewing a TD-OCT, and then again after reviewing a SD-OCT.
Data were collected for 129 treatment decision pairs involving 67 eyes from 46 subjects. Nonconcordant decisions occurred in 9 (7%) treatment decision pairs. In 7 of these (5%, 95% confidence interval [CI]: 2%-11%), the addition of SD-OCT changed the retina specialist's decision from not recommending to recommending retreatment. The addition of SD-OCT increased the certainty of the retina specialist in 36% (95% CI: 27%-45%) of all treatment decision pairs.
Spectral-domain OCT does not appear to change the ultimate treatment decision or increase the level of certainty of the retina specialist relative to TD-OCT in most cases of DME under anti-VEGF management in clinical practice. The few nonconcordant decisions appear to trend toward recommending more anti-VEGF therapy following SD-OCT.
一些临床试验基于视力和时域光相干断层扫描（TD-OCT）中心视网膜厚度变化来证明抗 VEGF 治疗糖尿病性黄斑水肿（DME）的益处，从而重新评估治疗决策。本研究评估了在接受抗 VEGF 药物治疗 DME 时，在需要时进行 TD-OCT 后再进行谱域（SD）-OCT 对治疗决策的影响。
经威尔默眼科研究所视网膜科机构审查委员会批准知情同意程序，先前接受过抗 VEGF 药物治疗的 DME 患者接受了临床检查、TD-OCT 和 SD-OCT 成像。他们的视网膜专家在进行临床检查和查看 TD-OCT 后，记录是否建议进行额外的抗 VEGF 治疗，并在查看 SD-OCT 后再次记录他们在该决定中的确定性程度。
共收集了 46 名患者 67 只眼的 129 对治疗决策数据。在 9 对（7%）治疗决策中存在不一致的决策。在这 7 对（5%，95%置信区间[CI]：2%-11%）中，添加 SD-OCT 改变了视网膜专家的决策，从不建议转为建议再次治疗。在所有治疗决策对中，SD-OCT 增加了视网膜专家确定性的比例为 36%（95%CI：27%-45%）。
在大多数情况下，与 TD-OCT 相比，SD-OCT 似乎不会改变抗 VEGF 管理下 DME 的最终治疗决策或增加视网膜专家的确定性水平。少数不一致的决策似乎倾向于在进行 SD-OCT 后推荐更多的抗 VEGF 治疗。
