Sydney Medical School, University of Sydney, Sydney, Australia.
School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
Graefes Arch Clin Exp Ophthalmol. 2022 Jan;260(1):1-23. doi: 10.1007/s00417-021-05271-4. Epub 2021 Jul 5.
This study aims to review the literature that compares the accuracy of Anterior Segment-Optical Coherence Tomography (AS-OCT) against gonioscopy in detecting eyes with angle closure. It is currently unclear how AS-OCT fits into clinical practice for detecting angle closure. This is a systematic review and meta-analysis.
A literature search was performed on Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials to identify studies that investigated the diagnostic accuracy of AS-OCT in detecting eyes with angle closure as diagnosed by gonioscopy. Eligible studies included in the analysis met stringent inclusion criteria determining the sensitivity and specificity of AS-OCT.
The initial search identified 727 studies, of which 23 were included in the final analysis. We found substantial variation in the parameters being studied and methodologies. The sensitivity of AS-OCT ranged from 46 to 100% (median 87%). Twenty-one studies identified parameters that showed sensitivity above 80%. The specificity ranged from 55.3 to 100% (median 84%).
AS-OCT demonstrates good sensitivity for detecting angle closure. It may provide an avenue to address high rates of undiagnosed angle closure, such as found in developing Asian countries. However, AS-OCT is not yet able to replace gonioscopy. Clinicians should consider whether the diagnostic accuracy of AS-OCT is acceptable for their specific clinical use before adopting it. More studies are needed to determine the utility of AS-OCT, including longitudinal studies to determine the significance of eyes classified to have closed angles by AS-OCT but open on gonioscopy.
本研究旨在回顾比较前节光学相干断层扫描（AS-OCT）与房角镜检测眼前段闭角的准确性的文献。目前尚不清楚 AS-OCT 在检测眼前段闭角的临床实践中如何应用。这是一项系统评价和荟萃分析。
对 Medline、Embase、Scopus 和 Cochrane 对照试验中心注册数据库进行文献检索，以确定调查 AS-OCT 检测房角镜诊断的眼前段闭角准确性的研究。分析中纳入的合格研究符合严格的纳入标准，确定了 AS-OCT 的敏感性和特异性。
最初的搜索确定了 727 项研究，其中 23 项被纳入最终分析。我们发现正在研究的参数和方法存在很大差异。AS-OCT 的敏感性范围为 46%至 100%（中位数 87%）。21 项研究确定了敏感性高于 80%的参数。特异性范围为 55.3%至 100%（中位数 84%）。
AS-OCT 对检测眼前段闭角具有良好的敏感性。它可能为解决未确诊的眼前段闭角（如在亚洲发展中国家）提供途径。然而，AS-OCT 还不能替代房角镜。临床医生应在采用 AS-OCT 之前，考虑其对特定临床应用的诊断准确性是否可以接受。需要更多的研究来确定 AS-OCT 的实用性，包括确定 AS-OCT 分类为闭角但房角镜检查为开角的眼睛的意义的纵向研究。
