von der Burchard Claus, Treumer Felix, Ehlken Christoph, Koinzer Stefan, Purtskhvanidze Konstantine, Tode Jan, Roider Johann
Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
Graefes Arch Clin Exp Ophthalmol. 2018 Sep;256(9):1623-1629. doi: 10.1007/s00417-018-4040-7. Epub 2018 Jun 18.
Current algorithms for automated computer interpretation of optical coherence tomography (OCT) imaging of patients suffering from neovascular age-related macular degeneration (AMD) mostly rely on fluid detection. However, fluid detection itself and correct interpretation of the fluid currently limits diagnostic accuracy. We therefore performed a detailed analysis of the requirements that would have to be met for fluid detection approaches. We further investigated if monitoring retinal volume would be a viable alternative to detect disease activity.
Retrospective analysis and manual grading of 764 OCT volume scans of 44 patients with exudative AMD treated with intravitreal anti-VEGF injections at a pro-re-nata (PRN) treatment regimen for at least 24 months.
Detection of subretinal fluid (SRF) or intraretinal fluid (IRF) alone is not sufficient for disease detection. A combination of SRF and IRF can detect disease activity with a sensitivity of 98.6% and a specificity of 82%. With further characterization of IRF into exudative and degenerative cysts, specificity can be increased to 100%. However, correct characterization is currently not achieved by published fluid detection approaches. Change of macular retinal volume (MRV) can depict disease activity with sensitivity of 88.4% and specificity of 89.6%. Combination with the detection of SRF can further improve diagnostic accuracy to a specificity of 93.3% and sensitivity of 93.9% without relying on IRF or IRF characterization.
Fluid detection without further characterization is not sufficient for AMD monitoring. Either further distinction between exudative and degenerative cysts is necessary, or other activity markers have to be taken into account. MRV offers good potential to fill this diagnostic gap and might become an important monitoring marker.
目前用于对患有新生血管性年龄相关性黄斑变性（AMD）患者的光学相干断层扫描（OCT）成像进行自动计算机解读的算法大多依赖于液体检测。然而，液体检测本身以及对液体的正确解读目前限制了诊断准确性。因此，我们对液体检测方法必须满足的要求进行了详细分析。我们还进一步研究了监测视网膜体积是否是检测疾病活动的可行替代方法。
对44例接受玻璃体内抗VEGF注射按需（PRN）治疗方案至少24个月的渗出性AMD患者的764次OCT体积扫描进行回顾性分析和人工分级。
仅检测视网膜下液（SRF）或视网膜内液（IRF）不足以进行疾病检测。SRF和IRF联合检测疾病活动的灵敏度为98.6%，特异性为82%。将IRF进一步分为渗出性囊肿和退行性囊肿，特异性可提高到100%。然而，目前已发表的液体检测方法尚未实现正确的分类。黄斑视网膜体积（MRV）的变化可描绘疾病活动，灵敏度为88.4%，特异性为89.6%。与SRF检测相结合可进一步提高诊断准确性，特异性达到93.3%，灵敏度达到93.9%，而无需依赖IRF或IRF分类。
未经进一步分类的液体检测不足以监测AMD。要么有必要进一步区分渗出性囊肿和退行性囊肿，要么必须考虑其他活动标志物。MRV有很好的潜力填补这一诊断空白，可能成为一个重要的监测标志物。
