Ohno-Matsui Kyoko, Kawasaki Ryo, Jonas Jost B, Cheung Chui Ming Gemmy, Saw Seang-Mei, Verhoeven Virginie J M, Klaver Caroline C W, Moriyama Muka, Shinohara Kosei, Kawasaki Yumiko, Yamazaki Mai, Meuer Stacy, Ishibashi Tatsuro, Yasuda Miho, Yamashita Hidetoshi, Sugano Akira, Wang Jie Jin, Mitchell Paul, Wong Tien Yin
Tokyo Medical and Dental University, Tokyo, Japan.
Department of Public Health, Yamagata University, Yamagata, Japan.
Am J Ophthalmol. 2015 May;159(5):877-83.e7. doi: 10.1016/j.ajo.2015.01.022. Epub 2015 Jan 26.
To develop a classification and grading system for myopic maculopathy.
Development and evaluation of a classification system for myopic maculopathy based on observational case series.
A comprehensive set of myopic macular lesions was defined via literature review and through consensus meetings among retinal specialists and clinician scientists. A classification of myopic maculopathy was formulated based on fundus photographs and a modified Delphi process and consensus. Inter- and intraobserver reproducibility, assessed as agreement (%) and weighted kappa values, were evaluated. One hundred retinal photographs with myopia and myopic macular lesions were selected from case series at the High Myopia Clinic of the Tokyo Medical and Dental University, Tokyo, Japan.
We defined 5 categories of myopic maculopathy including "no myopic retinal degenerative lesion" (Category 0), "tessellated fundus" (Category 1), "diffuse chorioretinal atrophy" (Category 2), "patchy chorioretinal atrophy" (Category 3), and "macular atrophy" (Category 4). Three additional features to supplement these categories were defined as "plus" lesions, namely, lacquer cracks, myopic choroidal neovascularization, and Fuchs spot. Posterior staphyloma was considered as a further, important sign of myopic retinopathy. The intraobserver agreement was ≥85% and the corresponding weighted kappa statistic was ≥0.6 between observations. After a brief training session, interobserver kappa statistics reached the predefined satisfactory level (≥0.4), considered as above moderate agreement.
We propose a classification system for myopic maculopathy that was found to be reproducible. Applying a uniform classification in different studies will facilitate communication and comparison of findings from clinical trials and epidemiologic studies.
建立一种近视性黄斑病变的分类和分级系统。
基于观察性病例系列对近视性黄斑病变分类系统进行开发和评估。
通过文献综述以及视网膜专家和临床科学家的共识会议，确定了一组全面的近视性黄斑病变。基于眼底照片、改良的德尔菲法和共识制定了近视性黄斑病变的分类。评估了观察者间和观察者内的可重复性，以一致性（%）和加权kappa值进行评估。从日本东京医科齿科大学高度近视诊所的病例系列中选取了100张患有近视和近视性黄斑病变的视网膜照片。
我们定义了5类近视性黄斑病变，包括“无近视性视网膜退行性病变”（0类）、“棋盘状眼底”（1类）、“弥漫性脉络膜视网膜萎缩”（2类）、“斑片状脉络膜视网膜萎缩”（3类）和“黄斑萎缩”（4类）。定义了另外三个补充这些类别的特征为“加”性病变，即漆裂纹、近视性脉络膜新生血管和Fuchs斑。后巩膜葡萄肿被认为是近视性视网膜病变的另一个重要体征。观察者内一致性≥85%，观察之间相应的加权kappa统计量≥0.6。经过简短的培训课程后，观察者间kappa统计量达到了预先定义的满意水平（≥0.4），即被认为是中度以上的一致性。
我们提出了一种被发现具有可重复性的近视性黄斑病变分类系统。在不同研究中应用统一分类将有助于临床试验和流行病学研究结果的交流和比较。
