Qin Yingyan, Ye Shaobi, Liu Liangping, Wu Mingxing
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Ann Transl Med. 2022 Aug;10(15):815. doi: 10.21037/atm-22-341.
Preoperative evaluation of macular disorders is crucial to predict postoperative visual outcomes among patients with cataract. The swept-source optical coherence tomography (SS-OCT) based optical biometer was proved to be useful in screening macular pathology, while the impact of lens opacities and axial lengths on macular disease screening using SS-OCT based optical biometer remained unknown. This study aimed to evaluate the influence of lens opacities and axial lengths on foveal image quality detected by SS-OCT-based optical biometer, as well as sensitivity and specificity for the detection of macular diseases.
This was a diagnostic accuracy study that retrospectively included patients who underwent preoperative cataract examinations at our hospital between November 2020 and June 2021. All patients underwent SS-OCT based optical biometer and spectral-domain OCT (SD-OCT). The SD-OCT was the golden standard for diagnosing macular diseases. Sensitivity, specificity, and receiver operating characteristic (ROC) were calculated to evaluate the value of foveal SS-OCT scans for the detection of macular disease.
Of the 224 eyes enrolled in the study, 82 eyes were diagnosed with macular disease by SD-OCT. The foveal image was almost indistinguishable due to poor quality when the mean grayscale of the image was less than 40. The posterior subcapsular opacity score and the axial length were significantly correlated with the gray density of the foveal image (r=-0.70, P<0.0001 and r=-0.40, P<0.0001). After excluding cases with indistinguishable foveal images (subcapsular opacities score ≥3.5, axial length ≥28.9 mm), the SS-OCT yielded 68% (95% confidence interval, 0.54-0.79) sensitivity and 87% (95% confidence interval, 0.78-0.92) specificity in 136 eyes.
Routine SS-OCT based biometric measurement for the evaluation of macular pathology simultaneously prior to cataract surgery is suggested except for patients with advanced cataract (posterior subcapsular opacities score ≥3.5) and long axial length (≥28.9 mm).
黄斑疾病的术前评估对于预测白内障患者的术后视力结果至关重要。基于扫频光学相干断层扫描（SS-OCT）的光学生物测量仪已被证明在筛查黄斑病变方面有用，而晶状体混浊和眼轴长度对使用基于SS-OCT的光学生物测量仪进行黄斑疾病筛查的影响尚不清楚。本研究旨在评估晶状体混浊和眼轴长度对基于SS-OCT的光学生物测量仪检测到的黄斑中心凹图像质量的影响，以及对黄斑疾病检测的敏感性和特异性。
这是一项诊断准确性研究，回顾性纳入了2020年11月至2021年6月期间在我院接受术前白内障检查的患者。所有患者均接受了基于SS-OCT的光学生物测量仪和光谱域光学相干断层扫描（SD-OCT）检查。SD-OCT是诊断黄斑疾病的金标准。计算敏感性、特异性和受试者操作特征（ROC）曲线以评估黄斑中心凹SS-OCT扫描对黄斑疾病检测的价值。
在纳入研究的224只眼中，82只眼经SD-OCT诊断为黄斑疾病。当图像的平均灰度小于40时，由于质量差，黄斑中心凹图像几乎无法分辨。后囊下混浊评分和眼轴长度与黄斑中心凹图像的灰度密度显著相关（r=-0.70，P<0.0001和r=-0.40，P<0.0001）。在排除黄斑中心凹图像无法分辨的病例（后囊下混浊评分≥3.5，眼轴长度≥28.9mm）后，136只眼中SS-OCT的敏感性为68%（95%置信区间，0.54-0.79），特异性为87%（95%置信区间，0.78-0.92）。
除了患有晚期白内障（后囊下混浊评分≥3.5）和眼轴长度较长（≥28.9mm）的患者外，建议在白内障手术前常规使用基于SS-OCT的生物测量方法同时评估黄斑病变。
