三维内皮层-Descemet 复合体厚度在 Fuchs 内皮细胞营养不良中的诊断性能。
Diagnostic Performance of 3-Dimensional Thickness of the Endothelium-Descemet Complex in Fuchs' Endothelial Cell Corneal Dystrophy.
机构信息
Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Department of Ophthalmology, Faculty of Medicine, Benha University, Banha, Egypt.
Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Electrical and Computer Engineering, University of Miami, Miami, Florida.
出版信息
Ophthalmology. 2020 Jul;127(7):874-887. doi: 10.1016/j.ophtha.2020.01.021. Epub 2020 Jan 19.
PURPOSE
To describe the diagnostic accuracy of 3-dimensional (3D) endothelium-Descemet's membrane complex thickness (En-DMT) in Fuchs' endothelial corneal dystrophy (FECD) and determine its potential role as an objective index of disease severity.
DESIGN
Observational case-control study.
PARTICIPANTS
One hundred four eyes of 79 participants (64 eyes of 41 FECD patients and 40 eyes of 38 healthy controls).
METHODS
All participants received high-definition OCT imaging (Envisu R2210; Bioptigen, Buffalo Grove, IL). Fuchs' endothelial corneal dystrophy was classified clinically into early-stage (without edema) and late-stage (with edema) disease. Automatic and manual segmentation of corneal layers was performed using a custom-built segmental tomography algorithm to generate 3D maps of total corneal thickness (TCT) and En-DMT of the central 6-mm cornea. Regional En-DMT, regional TCT, and central-to-peripheral total corneal thickness ratio (CPTR) were evaluated and correlated to the clinical severity of FECD. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to assess the reliability of the repeated measurements in all eyes.
MAIN OUTCOME MEASURES
Central-to-peripheral total corneal thickness ratio and average En-DMT and TCT of central, paracentral, and peripheral regions.
RESULTS
In FECD, a significant increase in En-DMT, CPTR and TCT was found compared to controls (P < 0.001). For identifying FECD, average En-DMT of paracentral and peripheral regions achieved 94% sensitivity and 100% specificity (cutoffs, 19 μm and 20 μm, respectively), whereas CPTR showed 94% sensitivity with a 73% specificity (cutoff, 0.97). Regarding early-stage FECD, average En-DMT of central zones achieved 92% sensitivity and 97% specificity (cutoff, 18 μm), whereas CPTR showed 90% sensitivity and 88% specificity (cutoff, 0.97). The average En-DMT of central, paracentral, and peripheral regions was correlated highly with FECD clinical stage (Spearman's ρ = 0.813, 0.793, and 0.721, respectively; all P < 0.001), compared with CPTR and mean TCT of paracentral zones (0.672 and 0.481, respectively; P < 0.001). The ICC values ranged from 0.98 (En-DMT) to 0.99 (TCT) with a good agreement between the automatic and manual measurements.
CONCLUSIONS
Regional 3D En-DMT is a novel diagnostic tool of FECD that can be used to quantify the disease severity with excellent reliability.
目的
描述 3 维（3D）内皮-Descemet 膜复合体厚度（En-DMT）在 Fuchs 内皮角膜营养不良（FECD）中的诊断准确性，并确定其作为疾病严重程度的客观指标的潜在作用。
设计
观察性病例对照研究。
参与者
79 名参与者的 104 只眼（41 名 FECD 患者的 64 只眼和 38 名健康对照者的 40 只眼）。
方法
所有参与者均接受高清晰度 OCT 成像（Envisu R2210；Bioptigen，Buffalo Grove，IL）。根据临床将 Fuchs 内皮角膜营养不良分为早期（无水肿）和晚期（有水肿）疾病。使用定制的分段层析成像算法自动和手动分割角膜层，以生成中央 6 毫米角膜的全角膜厚度（TCT）和 En-DMT 的 3D 图。评估局部 En-DMT、局部 TCT 和中央-周边总角膜厚度比（CPTR），并与 FECD 的临床严重程度相关。使用组内相关系数（ICCs）和 Bland-Altman 图评估所有眼的重复测量的可靠性。
主要观察指标
中央-周边总角膜厚度比以及中央、旁中央和周边区域的平均 En-DMT 和 TCT。
结果
与对照组相比，FECD 中 En-DMT、CPTR 和 TCT 显著增加（P<0.001）。用于识别 FECD 的是，旁中央和周边区域的平均 En-DMT 达到了 94%的灵敏度和 100%的特异性（截断值分别为 19 μm 和 20 μm），而 CPTR 的灵敏度为 94%，特异性为 73%（截断值为 0.97）。对于早期 FECD，中央区的平均 En-DMT 达到 92%的灵敏度和 97%的特异性（截断值为 18 μm），而 CPTR 的灵敏度为 90%，特异性为 88%（截断值为 0.97）。中央、旁中央和周边区域的平均 En-DMT 与 FECD 临床分期高度相关（Spearman's ρ分别为 0.813、0.793 和 0.721；均 P<0.001），而 CPTR 和旁中央区的平均 TCT 相关性较低（分别为 0.672 和 0.481；均 P<0.001）。ICC 值范围为 0.98（En-DMT）至 0.99（TCT），自动和手动测量之间具有良好的一致性。
结论
局部 3D En-DMT 是一种用于量化疾病严重程度的新型 FECD 诊断工具，具有极好的可靠性。
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