Bertelmann Thomas, Wachtlin Joachim, Mennel Stefan, Koss Michael J, Maier Mathias M, Schumann Ricarda G, Kazerounian Sara, Daniel Hanna, Schmitz-Valckenberg Steffen
Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Straße 40, 35075, Goettingen, Germany.
Department of Ophthalmology, Sankt Gertrauden Krankenhaus, Berlin, Germany.
Graefes Arch Clin Exp Ophthalmol. 2017 Jul;255(7):1359-1367. doi: 10.1007/s00417-017-3657-2. Epub 2017 Apr 7.
To evaluate the agreement and predictability of ocriplasmin treatment effects among retinal experts (raters) by assessment of retinal imaging data of eyes treated for vitreomacular traction in nine different centers in Germany and Austria.
Retrospective cohort study. Combined confocal near-infrared scanning laser ophthalmoscopy and spectral-domain optical coherence tomography images (Spectralis® device, Heidelberg Engineering GmbH, Germany) from 136 eyes of 135 subjects were reviewed by 14 raters using an internet-based grading database and a standardized questionnaire. In addition to the images taken within 2 days prior to treatment, age, gender, and lens status were disclosed to the raters. Treatment success was defined as a complete cleavage of the posterior vitreous cortex at day 28±5. Main outcome was the agreement and predictability among raters for assessment of treatment success.
Raters generally accepted starting ocriplasmin treatment (chance for treatment success ≥ 1%) in 22.4 to 69.1% (median 53.2%) of eyes (moderate intra- and interrater agreements with kappa-values of 0.6 and 0.48). The likelihood for a high potential treatment success (equal or higher than 25%) was judged by the raters in 43.4% to 86.0% (median 62.6%) of eyes (moderate intra- and fair interrater agreements with kappa-values of 0.56 and 0.22). Allocating eyes for high potential treatment success overall increased the odds by 3.07, with odds ratios of single raters up to 4.06 to 6.16.
These results underscore the importance of training health care providers in the evaluation of retinal imaging data and also to define characteristic morphological features better in the presence of vitreoretinal interface diseases. The better results of single raters in the predictability of treatment success by the allocation of eyes in the high-potential group indicates the high relevance of the meticulous analysis of retinal images.
通过评估德国和奥地利九个不同中心接受玻璃体黄斑牵引治疗的眼睛的视网膜成像数据，评价视网膜专家（评估者）之间奥克纤溶酶治疗效果的一致性和可预测性。
回顾性队列研究。14名评估者使用基于互联网的分级数据库和标准化问卷，对135名受试者的136只眼睛的共聚焦近红外扫描激光检眼镜和光谱域光学相干断层扫描图像（Spectralis®设备，德国海德堡工程有限公司）进行了回顾。除了治疗前2天内拍摄的图像外，还向评估者披露了年龄、性别和晶状体状态。治疗成功定义为在第28±5天时后玻璃体皮质完全脱离。主要结果是评估者之间在评估治疗成功方面的一致性和可预测性。
评估者普遍认为在22.4%至69.1%（中位数53.2%）的眼睛中开始使用奥克纤溶酶治疗（治疗成功的机会≥1%）（评估者内和评估者间一致性中等，kappa值分别为0.6和0.48）。评估者判断在43.4%至86.0%（中位数62.6%）的眼睛中具有高潜在治疗成功可能性（等于或高于25%）（评估者内一致性中等，评估者间一致性一般，kappa值分别为0.56和0.22）。总体而言，将眼睛分配为具有高潜在治疗成功可能性会使几率增加3.07，单个评估者的优势比高达4.06至6.16。
这些结果强调了培训医疗保健提供者评估视网膜成像数据以及在存在玻璃体视网膜界面疾病时更好地定义特征形态学特征的重要性。通过将眼睛分配到高潜力组，单个评估者在治疗成功可预测性方面取得的更好结果表明了仔细分析视网膜图像的高度相关性。
