Wenzel Daniel A, Poli Sven, Casagrande Maria, Druchkiv Vasyl, Spitzer Martin S, Bartz-Schmidt Karl Ulrich, Grohmann Carsten, Schultheiss Maximilian
University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany.
Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Front Med (Lausanne). 2022 Jul 6;9:854288. doi: 10.3389/fmed.2022.854288. eCollection 2022.
To investigate inner retinal hyperreflectivity on optical coherence tomography (OCT) as a potential biomarker indicating acute central retinal artery occlusion (CRAO).
A total of 56 patients at two university hospitals with acute CRAO (symptom onset ≤48 h) were included in this retrospective study. The optical intensity of the inner retinal layers was determined in both eyes and the relationship between symptom onset and inner retinal layer optical intensity in OCT scans compared to the unaffected fellow eye was analyzed. Several differential diagnoses [central retinal vein occlusion, anterior ischemic optic neuropathy, diabetic macular edema, and subretinal fibrosis/disciform scar (Junius-Kuhnt)] served as controls to validate optical intensity-based diagnosis of CRAO.
CRAO strongly correlated with an increased inner retinal layer hyperreflectivity in this cohort with acute CRAO with a time since symptom onset ranging from 1.1 to 48.0 h. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.99 to confirm CRAO with a true positive rate of 0.93 and a false positive rate of 0.02. No correlation between optical intensity and time since symptom onset was noticeable. None of the differential diagnoses did show an elevated optical intensity of the inner retinal layers as it was detectable in CRAO.
OCT-based determination of inner retinal layer hyperreflectivity is a very promising biomarker for a prompt diagnosis of CRAO in an emergency setting. This may be of major interest to speed up the administration of a possible thrombolytic treatment.
研究光学相干断层扫描（OCT）上的视网膜内层高反射率作为急性视网膜中央动脉阻塞（CRAO）潜在生物标志物的情况。
本回顾性研究纳入了两家大学医院共56例急性CRAO（症状发作≤48小时）患者。测定双眼视网膜内层的光强度，并分析症状发作与OCT扫描中视网膜内层光强度之间的关系，与未受影响的对侧眼进行比较。几种鉴别诊断[视网膜中央静脉阻塞、前部缺血性视神经病变、糖尿病性黄斑水肿和视网膜下纤维化/盘状瘢痕（朱尼厄斯 - 昆特）]作为对照，以验证基于光强度的CRAO诊断。
在该急性CRAO队列中，症状发作时间为1.1至48.0小时，CRAO与视网膜内层高反射率增加密切相关。受试者操作特征（ROC）分析显示曲线下面积为0.99，确诊CRAO的真阳性率为0.93，假阳性率为0.02。未观察到光强度与症状发作时间之间的相关性。在鉴别诊断中，没有一种显示出如CRAO中可检测到的视网膜内层光强度升高。
基于OCT测定视网膜内层高反射率是在紧急情况下快速诊断CRAO的非常有前景的生物标志物。这对于加快可能的溶栓治疗的实施可能具有重要意义。
