Toth Cynthia A, Decroos Francis Char, Ying Gui-Shuang, Stinnett Sandra S, Heydary Cynthia S, Burns Russell, Maguire Maureen, Martin Daniel, Jaffe Glenn J
*Duke University Eye Center, Department of Ophthalmology, Durham, North Carolina; †Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; and ‡Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Retina. 2015 Jul;35(7):1303-14. doi: 10.1097/IAE.0000000000000483.
To examine treatment decisions by ophthalmologists versus reading center fluid identification from optical coherence tomography in Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).
Fluid in 6,210 optical coherence tomography scans (598 patients) in "as needed treatment" arm of CATT Year 1 was compared with ophthalmologist's treatment: positive fluid agreement (PFA, fluid+, treatment+) and positive fluid discrepancy (PFD, fluid+, treatment-), negative fluid agreement (fluid-, treatment-) and negative fluid discrepancy (fluid-, treatment+). For PFDs, fluid location and visual acuity were characterized.
Treatment and reading center fluid determination agreed in 72.1% (53.0% PFA, 19.1% negative fluid agreement) and disagreed in 27.9% (25.7% PFD, 2.2% negative fluid discrepancy) of visits, with no discrepancies for 20.9% of patients. Compared with PFA, PFD occurred more commonly with lower total foveal thickness (mean ± SD: 265 ± 103 PFD, 366 ± 151 μm PFA), presence of intraretinal fluid only, smaller fluid areas (PFA areas greater than twice those of PFD, P < 0.001), and greater decrease in retinal and lesion thickness. Mean acuities before, at, and after PFD were 65.8, 66.9, and 66.3 letters.
Treatment decisions by ophthalmologists matched reading center fluid determination in the majority of visits. More pronounced response to treatment and smaller foci of fluid likely contributed to PFD. Positive fluid discrepancy did not have substantial impact on subsequent visual acuity.
在年龄相关性黄斑变性治疗试验比较（CATT）中，比较眼科医生的治疗决策与光学相干断层扫描阅读中心对液体的识别情况。
将CATT研究第1年“按需治疗”组中6210次光学相干断层扫描（598例患者）中的液体情况与眼科医生的治疗情况进行比较：液体阳性一致性（PFA，液体阳性、治疗阳性）、液体阳性差异（PFD，液体阳性、治疗阴性）、液体阴性一致性（液体阴性、治疗阴性）和液体阴性差异（液体阴性、治疗阳性）。对于PFD情况，对液体位置和视力进行了特征描述。
在72.1%的就诊中，治疗与阅读中心对液体的判定一致（53.0%为PFA，19.1%为液体阴性一致性），27.9%不一致（25.7%为PFD，2.2%为液体阴性差异），20.9%的患者无差异。与PFA相比，PFD更常见于总黄斑中心凹厚度较低时（均值±标准差：PFD为265±103μm，PFA为366±151μm）、仅存在视网膜内液体时、液体区域较小（PFA区域大于PFD区域的两倍，P<0.001）以及视网膜和病变厚度下降更大时。PFD发生前、发生时和发生后的平均视力分别为65.8、66.9和66.3字母。
在大多数就诊中，眼科医生的治疗决策与阅读中心对液体的判定相符。对治疗更明显的反应和较小的液体病灶可能导致了PFD。液体阳性差异对后续视力没有实质性影响。
