Nguyen Thanh-Tin P, Ni Shuibin, Ostmo Susan, Rajagopalan Archeta, Coyner Aaron S, Woodward Mani, Chiang Michael F, Jia Yali, Huang David, Campbell J Peter, Jian Yifan
Casey Eye Institute, Oregon Health & Science University, Portland.
Department of Biomedical Engineering, Oregon Health & Science University, Portland.
JAMA Ophthalmol. 2022 Oct 13;140(11):1121-7. doi: 10.1001/jamaophthalmol.2022.4173.
Accurate diagnosis of retinopathy of prematurity (ROP) is essential to provide timely treatment and reduce the risk of blindness. However, the components of an ROP examination are subjective and qualitative.
To evaluate whether optical coherence tomography (OCT)-derived retinal thickness measurements at the vascular-avascular junction are associated with clinical diagnosis of ROP stage.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional longitudinal study compared OCT-based ridge thickness calculated from OCT B-scans by a masked examiner to the clinical diagnosis of 2 masked examiners using both traditional stage classifications and a more granular continuous scale at the neonatal intensive care unit (NICU) of Oregon Health & Science University (OHSU) Hospital. Infants who met ROP screening criteria in the OHSU NICU between June 2021 and April 2022 and had guardian consent were included. One OCT volume and en face image per patient per eye showing at least 1 to 2 clock hours of ridge were included in the final analysis.
Comparison of OCT-derived ridge thickness to the clinical diagnosis of ROP stage using an ordinal and continuous scale. Repeatability was assessed using 20 repeated examinations from the same visit and compared using intraclass correlation coefficient (ICC) and coefficient of variation (CV). Comparison of ridge thickness with ordinal categories was performed using generalized estimating equations and with continuous stage using Spearman correlation.
A total of 128 separate OCT eye examinations from 50 eyes of 25 patients were analyzed. The ICC was 0.87 with a CV of 7.0%. Higher ordinal disease classification was associated with higher axial ridge thickness on OCT, with mean (SD) thickness measurements of 264.2 (11.2) μm (P < .001), 334.2 (11.4) μm (P < .001), and 495.0 (32.2) μm (P < .001) for stages 1, 2, and 3, respectively and with continuous stage labels (ρ = 0.739, P < .001).
These results suggest that OCT-based quantification of peripheral stage in ROP may be an objective and quantitative biomarker that may be useful for clinical diagnosis and longitudinal monitoring and may have implications for disease classification in the future.
准确诊断早产儿视网膜病变（ROP）对于及时治疗和降低失明风险至关重要。然而，ROP检查的组成部分是主观的且定性的。
评估光学相干断层扫描（OCT）在血管-无血管交界处测得的视网膜厚度是否与ROP分期的临床诊断相关。
设计、地点和参与者：这项横断面纵向研究将一位经过盲法培训的检查者根据OCT B扫描计算得出的基于OCT的嵴厚度，与另外两位经过盲法培训的检查者使用传统分期分类法和更精细的连续量表在俄勒冈健康与科学大学（OHSU）医院新生儿重症监护病房（NICU）进行的临床诊断进行比较。纳入了2021年6月至2022年4月期间在OHSU NICU符合ROP筛查标准且获得监护人同意的婴儿。最终分析纳入每位患者每只眼睛的一个OCT容积和正面图像，显示至少1至2个钟点的嵴。
使用有序和连续量表将OCT得出的嵴厚度与ROP分期的临床诊断进行比较。使用同一次就诊的20次重复检查评估重复性，并使用组内相关系数（ICC）和变异系数（CV）进行比较。使用广义估计方程对嵴厚度与有序类别进行比较，使用Spearman相关性对嵴厚度与连续分期进行比较。
共分析了来自25例患者50只眼睛的128次单独的OCT眼部检查。ICC为0.87，CV为7.0%。较高的有序疾病分类与OCT上较高的轴向嵴厚度相关，1期、2期和3期的平均（标准差）厚度测量值分别为264.2（11.2）μm（P < 0.001）、334.2（11.4）μm（P < 0.001）和495.0（32.2）μm（P < 0.001），与连续分期标签也相关（ρ = 0.739，P < 0.001）。
这些结果表明，基于OCT对ROP周边分期进行量化可能是一种客观的定量生物标志物，可能有助于临床诊断和纵向监测，并且可能对未来的疾病分类有影响。
