Retina Division, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand.
Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Ophthalmol. 2019 Jun 1;137(6):661-667. doi: 10.1001/jamaophthalmol.2019.0565.
The use of indocyanine green angiography (ICGA) is a criterion standard for diagnosing polypoidal choroidal vasculopathy (PCV), an endemic and common cause of vision loss in Asian and African individuals that also presents in white individuals. However, the use of ICGA is expensive, invasive, and not always available at clinical centers. Therefore, knowing the value of certain features detected using fundus photography (FP), optical coherence tomography (OCT), and fluorescein angiography (FA) to diagnose PCV without ICGA could assist ophthalmologists to identify PCV when ICGA is not readily available.
To explore the sensitivity, specificity, and predictive accuracy of potential diagnostic features detected using FP, OCT, and FA in diagnosing PCV without ICGA.
DESIGN, SETTING, AND PARTICIPANTS: Deidentified images of FP alone, OCT alone, and FA alone were graded by 3 retina specialists masked to ICGA findings for potentially diagnostic features of PCV prespecified before grading compared with the criterion standard grading of 2 other retina specialists with access simultaneously to FP, OCT, FA and ICGA. Specialists graded images of 124 eyes of 120 patients presenting between January 1, 2013, and December 31, 2016, with newly identified serous or serosanguinous maculopathy who had undergone FP, OCT, FA, and ICGA before treatment at a large referral eye center in Thailand.
Sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy from the area under the receiver operating characteristic curve (AUC).
The mean (SD) age of the patients was 57.7 (12.6) years, 52 were women, 68 were men, and the diagnosis (from ICGA) was PCV for 65 eyes (52.4%), central serous chorioretinopathy for 45 eyes (36.3%), and typical neovascular age-related macular degeneration for 12 eyes (9.7%). With the use of FP, a potential diagnostic feature for PCV was notched or hemorrhagic pigment epithelial detachment (AUC, 0.77; 95% CI, 0.70-0.85). With the use of OCT, potential diagnostic features for PCV were pigment epithelial detachment notch (AUC, 0.90; 95% CI, 0.85-0.96), sharply peaked pigment epithelial detachment (AUC, 0.86; 95% CI, 0.80-0.92), and a hyperreflective ring (AUC, 0.86; 95% CI, 0.80-0.92). When at least 2 of these 4 signs were present, the AUC was 0.93 (95% CI, 0.89-0.98), with a sensitivity of 0.95 (95% CI, 0.87-0.99), a specificity of 0.95 (95% CI, 0.82-0.97), a positive predictive value of 0.92 (95% CI, 0.83-0.97), and a negative predictive value of 0.95 (95% CI, 0.86-0.99).
These data suggest that the potential diagnostic features detected using FP and OCT provide high sensitivity and specificity for a diagnosis of PCV, especially when at least 2 of 4 highly suggestive signs are present.
使用吲哚菁绿血管造影（ICGA）是诊断息肉样脉络膜血管病变（PCV）的标准，PCV 是亚洲和非洲人群常见的致盲原因，也见于白种人群。然而，ICGA 费用高、有创，且并非所有临床中心都能提供。因此，了解眼底照相术（FP）、光学相干断层扫描（OCT）和荧光素血管造影（FA）检测到的某些特征在没有 ICGA 的情况下诊断 PCV 的价值，可能有助于眼科医生在无法获得 ICGA 时识别 PCV。
探索 FP、OCT 和 FA 单独使用时检测到的潜在诊断特征在没有 ICGA 的情况下诊断 PCV 的敏感性、特异性和预测准确性。
设计、地点和参与者：在泰国一家大型转诊眼科中心，对 120 例 124 只眼患者的 FP 图像、OCT 图像和 FA 图像进行了分析，这些患者于 2013 年 1 月 1 日至 2016 年 12 月 31 日就诊，新出现浆液性或浆液血性黄斑病变，在治疗前均接受了 FP、OCT、FA 和 ICGA 检查。由 3 位视网膜专家对潜在的 PCV 特征进行了评估，这些特征在评分前已预先指定，而评分时这些专家并不知道 ICGA 的结果。另外 2 位视网膜专家同时获得 FP、OCT、FA 和 ICGA 的结果。
来自接受者操作特征曲线（AUC）下面积的敏感性、特异性、阳性预测值、阴性预测值和预测准确性。
患者的平均（标准差）年龄为 57.7（12.6）岁，52 例为女性，68 例为男性，根据 ICGA 诊断为 PCV 的有 65 只眼（52.4%）、中心性浆液性脉络膜视网膜病变的有 45 只眼（36.3%）和典型新生血管性年龄相关性黄斑变性的有 12 只眼（9.7%）。使用 FP 时，PCV 的潜在诊断特征为锯齿状或出血性色素上皮脱离（AUC，0.77；95%CI，0.70-0.85）。使用 OCT 时，PCV 的潜在诊断特征为色素上皮脱离切迹（AUC，0.90；95%CI，0.85-0.96）、陡峭尖的色素上皮脱离（AUC，0.86；95%CI，0.80-0.92）和高反射环（AUC，0.86；95%CI，0.80-0.92）。当存在上述 4 个特征中的至少 2 个时，AUC 为 0.93（95%CI，0.89-0.98），敏感性为 0.95（95%CI，0.87-0.99），特异性为 0.95（95%CI，0.82-0.97），阳性预测值为 0.92（95%CI，0.83-0.97），阴性预测值为 0.95（95%CI，0.86-0.99）。
这些数据表明，FP 和 OCT 检测到的潜在诊断特征对 PCV 的诊断具有较高的敏感性和特异性，尤其是当存在 4 个高度提示性特征中的至少 2 个时。
