Founti Panayiota, Narayan Akshay, Raja Aneela, Nathwani Neil, Tur Sergio Bordajandi, Thomas Rachel, Scott Andrew, Martins Alessandra, Nolan Winifred
Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Eye (Lond). 2024 Feb;38(3):514-519. doi: 10.1038/s41433-023-02713-7. Epub 2023 Sep 8.
BACKGROUND/OBJECTIVES: To investigate outcomes of referrals for suspected angle closure and explore whether anterior segment optical coherence tomography (AS-OCT) can be used to tighten triaging criteria in a glaucoma virtual clinic.
SUBJECTS/METHODS: Retrospectively collected data. The first audit (04/2018-03/2019) identified referrals for suspected angle closure without other glaucoma-related findings (primary angle closure suspect (PACS) referrals). All patients underwent gonioscopy. The second audit (04-08/2019) identified patients with suspected angle closure in a virtual clinic. Management outcomes were assessed, using gonioscopy as reference standard. The outcomes of the second audit were re-audited after changing the triaging criterion from angle width <10° to iridotrabecular contact (ITC) in ≥1 quadrants on AS-OCT.
Out of 1754 glaucoma referrals (first audit), 24.6% (431/1754) were PACS referrals. Of these, only 10.7% (42/393) had an occludable angle on gonioscopy, with 97.6% (41/42) being PACS. Of these, 78% (32/41) underwent laser peripheral iridotomy. Out of 137 referrals in the virtual clinic (second audit), 66.4% (91/137) were triaged to the face-to-face clinic. Of these, 31.9% (29/91) were discharged. AS-OCT had positive and negative predictive value of 74.3% (95% confidence intervals (CI) 57.8-86.0) and 82.1% (95% CI 70.0-90.2%), respectively, in detecting ITC in ≥1 quadrants. In the re-audit 45.9% (45/98) of those with suspected angle closure were triaged for gonioscopy, with 24.4% (11/45) of them being discharged.
PACS referrals represent a substantial burden to hospital-based services and their accuracy is low. ITC in ≥1 quadrants on AS-OCT can be useful in triaging those who need further evaluation with gonioscopy.
背景/目的：调查疑似闭角型青光眼转诊的结果，并探讨眼前节光学相干断层扫描（AS-OCT）是否可用于在青光眼虚拟诊所收紧分诊标准。
受试者/方法：回顾性收集数据。首次审核（2018年4月至2019年3月）确定了无其他青光眼相关发现的疑似闭角型青光眼转诊（原发性闭角型青光眼可疑病例（PACS）转诊）。所有患者均接受了前房角镜检查。第二次审核（2019年4月至8月）确定了虚拟诊所中疑似闭角型青光眼的患者。以房角镜检查作为参考标准评估管理结果。在将分诊标准从房角宽度<10°改为AS-OCT上≥1个象限的虹膜小梁接触（ITC）后，对第二次审核的结果进行了重新审核。
在1754例青光眼转诊病例（首次审核）中，24.6%（431/1754）为PACS转诊。其中，只有10.7%（42/393）在前房角镜检查时有可闭房角，97.6%（41/42）为PACS。其中，78%（32/41）接受了激光周边虹膜切开术。在虚拟诊所的137例转诊病例（第二次审核）中，66.4%（91/137）被分诊到面对面诊所。其中，31.9%（29/91）被出院。AS-OCT检测≥1个象限ITC的阳性预测值和阴性预测值分别为74.3%（95%置信区间（CI）57.8-86.0）和82.1%（95%CI 70.0-90.2%）。在重新审核中，45.9%（45/98）的疑似闭角型青光眼患者被分诊进行前房角镜检查，其中24.4%（11/45）被出院。
PACS转诊给医院服务带来了沉重负担，其准确性较低。AS-OCT上≥1个象限的ITC可用于分诊那些需要进一步进行前房角镜检查评估的患者。
