Sahoo Niroj K, Parameshwarappa Deepika C, Jhingan Mahima, Tatti Filippo, Iovino Claudio, Peiretti Enrico
Ophthalmology, L V Prasad Eye Institute, Anant Bajaj Retina Institute, Vijayawada, IND.
Ophthalmology, Seth Gordhandas Sunderdas Medical College, King Edward Memorial Hospital, Mumbai, IND.
Cureus. 2022 Jun 14;14(6):e25925. doi: 10.7759/cureus.25925. eCollection 2022 Jun.
Objective To validate the newly proposed multimodal-imaging-based classification for central serous chorioretinopathy (CSCR). Methods This was a retrospective study performed in a total of 87 eyes of 44 patients with a diagnosis of CSCR. Multimodal images in the form of auto-fluorescence, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT) images, of all the patients, were presented to two masked retina specialists. The masked observers graded each eye into simple or complex; primary, recurrent, resolved; and specific features such as foveal involvement, outer retinal atrophy, and choroidal neovascularization (CNV). Interobserver agreement was assessed using Cohen's kappa. In areas of non-consensus, a detailed discussion was carried out with a third independent grader. Results The mean age of the 44 patients (32 males and 12 females) was 49.2±9.3 years. We found a moderate-strong agreement between the two observers in all subclassifications, that included "simple or complex" (kappa value=0.91, 95% CI 0.82-0.99, p<0.001); "primary/recurrent/resolved" (kappa value=0.88, 95% CI 0.80-0.96, p<0.001) and "foveal involvement" (kappa value=0.89,95%CI 0.8-0.98, p<0.001). However, there was less agreement between the two graders with respect to classification of "outer retinal atrophy" (kappa value=0.72, 95%CI 0.57-0.87, p<0.001) and "presence/absence of CNV" (kappa value=0.75, 95% CI 0.58-0.92, p<0.001). Non-consensus in categorizing "outer retinal atrophy" was seen in eyes with sub-retinal hyper-reflective material (SHRM) and outer nuclear layer (ONL) thinning overlying subretinal fluid, and non-consensus in categorizing "CNV" was seen in eyes with inner choroidal atrophy. Conclusion Our study reports the validity and strong interobserver agreement in several aspects of the multimodal-imaging-based classification. This could support its implementation in clinical practice and pave way for appropriate treatment guidelines.
目的 验证新提出的基于多模态成像的中心性浆液性脉络膜视网膜病变（CSCR）分类方法。方法 这是一项回顾性研究，共纳入44例诊断为CSCR的患者的87只眼。将所有患者的自发荧光、眼底荧光血管造影、吲哚菁绿血管造影和光学相干断层扫描（OCT）图像形式的多模态图像呈现给两位不知情的视网膜专科医生。不知情的观察者将每只眼睛分为简单或复杂；原发、复发、已缓解；以及诸如黄斑受累、外层视网膜萎缩和脉络膜新生血管（CNV）等特定特征。使用Cohen's kappa评估观察者间的一致性。在存在分歧的区域，与第三位独立分级者进行详细讨论。结果 44例患者（32例男性和12例女性）的平均年龄为49.2±9.3岁。我们发现两位观察者在所有亚分类中均有中度至高度一致性，包括“简单或复杂”（kappa值=0.91，95%CI 0.82 - 0.99，p<0.001）；“原发/复发/已缓解”（kappa值=0.88，95%CI 0.80 - 0.96，p<0.001）和“黄斑受累”（kappa值=0.89，95%CI 0.8 - 0.98，p<0.001）。然而，两位分级者在“外层视网膜萎缩”分类（kappa值=0.72，95%CI 0.57 - 0.87，p<0.001）和“CNV的有无”分类（kappa值=0.75，95%CI 0.58 - 0.92，p<0.001）方面的一致性较低。在视网膜下高反射物质（SHRM）和外层视网膜下液上方外层核层（ONL）变薄的眼中，在“外层视网膜萎缩”分类上存在分歧，而在脉络膜内层萎缩的眼中，在“CNV”分类上存在分歧。结论 我们的研究报告了基于多模态成像的分类在几个方面的有效性和观察者间的高度一致性。这可以支持其在临床实践中的应用，并为制定适当的治疗指南铺平道路。
