Wilde C, Patel M, Lakshmanan A, Amankwah R, Dhar-Munshi S, Amoaku W
Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Ophthalmology, Derby Hospitals NHS Foundation Trust, Derby, UK.
Eye (Lond). 2015 May;29(5):602-9; quiz 610. doi: 10.1038/eye.2015.44. Epub 2015 Apr 24.
To evaluate the diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) for neovascular age-related macular degeneration (nAMD): a comparison against fundus fluorescein angiography (FFA).
A retrospective review of SD-OCT, colour fundus photographs (FP), and FFA of 411 consecutive patients referred to a rapid access Macular Clinic over a 4-year period was performed. FFA images were reviewed non-stereoscopically. SD-OCT images were acquired using the Topcon 3D OCT-1000 instrument. All FFA and OCT images were graded by at least two ophthalmologists independently. Side-by-side grading took place with immediate open discussion and adjudication. If there was disagreement between the two grading ophthalmologists or they were not 90% confident of their assigned grade, then adjudication by a third ophthalmologist was performed.
A total of 278 eyes were graded as having choroidal neovascularisation (CNV) with SD-OCT and 231 diagnosed with FFA. The main diagnostic CNV classifications on FFA were: classic no occult in 27 eyes, predominantly classic in 16, minimally classic in 50, occult in 129, and 9 peripapillary membranes. There were a total of 47 false positives with SD-OCT: a rate of 16.9%. The sensitivity and specificity of SD-OCT alone for detecting CNV was 100 and 80.8%, respectively.
Our study confirms SD-OCT in comparison to the reference standard of non-stereoscopic FFA is highly sensitive at detecting newly presenting nAMD in the setting of a specialist AMD clinic where the investigations are interpreted by trained specialists. However, it does not seem accurate enough to replace FFA in the diagnosis on nAMD in current practice.
评估光谱域光学相干断层扫描（SD-OCT）对新生血管性年龄相关性黄斑变性（nAMD）的诊断准确性，并与眼底荧光血管造影（FFA）进行比较。
对411例在4年期间转诊至快速就诊黄斑诊所的连续患者的SD-OCT、彩色眼底照片（FP）和FFA进行回顾性分析。FFA图像采用非立体方式进行阅片。使用Topcon 3D OCT-1000仪器采集SD-OCT图像。所有FFA和OCT图像均由至少两名眼科医生独立分级。分级过程中同时进行公开讨论和裁决。如果两名分级眼科医生之间存在分歧，或者他们对自己给出的分级没有90%的把握，那么由第三位眼科医生进行裁决。
SD-OCT将278只眼分级为脉络膜新生血管（CNV），FFA诊断出231只眼。FFA上主要的CNV诊断分类为：典型无隐匿性27只眼，主要为典型性16只眼，最小典型性50只眼，隐匿性129只眼，以及9只视乳头周围膜。SD-OCT共有47例假阳性：假阳性率为16.9%。单独使用SD-OCT检测CNV的敏感性和特异性分别为100%和80.8%。
我们的研究证实，与非立体FFA的参考标准相比，在由训练有素的专家解读检查结果的专科AMD诊所中，SD-OCT在检测新出现的nAMD方面具有高度敏感性。然而，在当前实践中，它在nAMD诊断中似乎还不够准确，无法取代FFA。
