Gerendas Bianca S, Waldstein Sebastian M, Simader Christian, Deak Gabor, Hajnajeeb Bilal, Zhang Li, Bogunovic Hrvoje, Abramoff Michael D, Kundi Michael, Sonka Milan, Schmidt-Erfurth Ursula
Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria.
Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria.
Am J Ophthalmol. 2014 Nov;158(5):1039-48. doi: 10.1016/j.ajo.2014.08.001. Epub 2014 Aug 12.
To measure choroidal thickness on spectral-domain optical coherence tomography (SD OCT) images using automated algorithms and to correlate choroidal pathology with retinal changes attributable to diabetic macular edema (DME).
Post hoc analysis of multicenter clinical trial baseline data.
SD OCT raster scans/fluorescein angiograms were obtained from 284 treatment-naïve eyes of 142 patients with clinically significant DME and from 20 controls. Three-dimensional (3D) SD OCT images were evaluated by a certified independent reading center analyzing retinal changes associated with diabetic retinopathy. Choroidal thicknesses were analyzed using a fully automated algorithm. Angiograms were assessed manually. Multiple endpoint correction according to Bonferroni-Holm was applied. Main outcome measures were average retinal/choroidal thickness on fovea-centered or peak of edema (thickest point of edema)-centered Early Treatment Diabetic Retinopathy Study grid, maximum area of leakage, and the correlation between retinal and choroidal thicknesses.
Total choroidal thickness is significantly reduced in DME (175 ± 23 μm; P = .0016) and nonedematous fellow eyes (177 ± 20 μm; P = .009) of patients compared with healthy control eyes (190 ± 23 μm). Retinal/choroidal thickness values showed no significant correlation (1-mm: P = .27, r(2) = 0.01; 3-mm: P = .96, r(2) < 0.0001; 6-mm: P = .42, r(2) = 0.006). No significant difference was found in the 1- or 3-mm circle of a retinal peak of edema-centered grid. All other measurements of choroidal/retinal thickness (DME vs healthy, DME vs peak of edema-centered, DME vs fellow, healthy vs fellow, peak of edema-centered vs healthy, peak of edema-centered vs fellow eyes) were compared but no statistically significant correlation was found. By tendency a thinner choroid correlates with larger retinal leakage areas.
Automated algorithms can be used to reliably assess choroidal thickness in eyes with DME. Choroidal thickness was generally reduced in patients with diabetes if DME is present in 1 eye; however, no correlation was found between choroidal/retinal pathologies, suggesting different pathogenetic pathways.
使用自动化算法在光谱域光学相干断层扫描（SD OCT）图像上测量脉络膜厚度，并将脉络膜病变与糖尿病性黄斑水肿（DME）所致的视网膜变化相关联。
多中心临床试验基线数据的事后分析。
从142例患有临床显著性DME的患者的284只未经治疗的眼睛以及20只对照眼中获取SD OCT光栅扫描/荧光素血管造影图像。三维（3D）SD OCT图像由一个经认证的独立阅读中心进行评估，分析与糖尿病视网膜病变相关的视网膜变化。使用全自动算法分析脉络膜厚度。手动评估血管造影图像。应用根据Bonferroni-Holm方法进行的多重终点校正。主要观察指标为以黄斑中心或水肿峰值（水肿最厚点）为中心的早期糖尿病性视网膜病变研究网格上的平均视网膜/脉络膜厚度、最大渗漏面积以及视网膜和脉络膜厚度之间的相关性。
与健康对照眼（190±23μm）相比，DME患者的患眼（175±23μm；P = 0.0016）和未发生水肿的对侧眼（177±20μm；P = 0.009）的脉络膜总厚度显著降低。视网膜/脉络膜厚度值无显著相关性（1mm：P = 0.27，r² = 0.01；3mm：P = 0.96，r² < 0.0001；6mm：P = 0.42，r² = 0.006）。在以水肿峰值为中心的视网膜网格的1mm或3mm范围内未发现显著差异。比较了脉络膜/视网膜厚度的所有其他测量值（DME与健康对照、DME与以水肿峰值为中心、DME与对侧眼、健康对照与对侧眼、以水肿峰值为中心与健康对照、以水肿峰值为中心与对侧眼），但未发现统计学上的显著相关性。脉络膜较薄往往与较大的视网膜渗漏面积相关。
自动化算法可用于可靠评估DME患者眼中的脉络膜厚度。如果一只眼睛存在DME，糖尿病患者的脉络膜厚度通常会降低；然而，未发现脉络膜/视网膜病变之间存在相关性，提示存在不同的发病机制。
