Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
Korean J Ophthalmol. 2023 Dec;37(6):468-476. doi: 10.3341/kjo.2023.0085. Epub 2023 Oct 25.
To compare the diagnostic accuracy of differentiating polypoidal choroidal vasculopathy (PCV) from exudative age-related macular degeneration (AMD), using color fundus photography (CFP), optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA) without using indocyanine green angiography (ICGA).
Treatment-naive eyes with exudative AMD that underwent CFP, OCT, SS-OCTA, and ICGA imaging before treatment were identified. Images of each patient were categorized into two sets (set A, CFP + OCT; set B, CFP + SS-OCTA). In set B, both the en face and cross-sectional B scans were analyzed. Each set was reviewed by two graders, and it was determined whether the presumed diagnosis was PCV. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for the diagnosis of PCV were assessed for each set by comparing diagnoses that included ICGA. The number of polypoidal lesions in each set was calculated and compared to ICGA.
A total of 94 eyes from 94 patients with AMD were included in the study, of which 66.0% were male, and the mean age was 71.8 ± 9.0 years. The PCV diagnosis rate using ICGA was 45.7%. The sensitivity was 0.88 for set A and 0.93 for set B, while the specificity was 0.94 for set A and 0.96 for set B. The AUC was 0.90 (95% confidence interval [CI], 0.83-0.97) for set A and 0.96 (95% CI, 0.90-1.00) for set B. Set A detected 1.28 ± 0.91 polypoidal lesions, while set B detected 1.47 ± 1.01; ICGA showed 1.51 ± 0.86.
This study highlights that, without using ICGA, both CFP combined with OCT and CFP combined with SS-OCTA demonstrate high sensitivity, specificity, and AUC in diagnosing PCV. It is evident that SS-OCTA contributes to enhancing sensitivity, specificity, and AUC for PCV diagnosis.
比较不使用吲哚青绿血管造影（ICGA）的情况下，彩色眼底照相术（CFP）、光学相干断层扫描（OCT）和扫频源 OCT 血管造影术（SS-OCTA）在鉴别息肉样脉络膜血管病变（PCV）和渗出性年龄相关性黄斑变性（AMD）中的诊断准确性。
筛选出经治疗前 CFP、OCT、SS-OCTA 和 ICGA 成像的未经治疗的渗出性 AMD 患眼。将每位患者的图像分为两组（A 组：CFP+OCT；B 组：CFP+SS-OCTA）。在 B 组中，对平面和横断面 B 扫描进行了分析。由两位评分者对每组图像进行评估，并确定假定的诊断是否为 PCV。通过比较包括 ICGA 的诊断，评估每组的 PCV 诊断的敏感性、特异性和受试者工作特征曲线（ROC）下面积（AUC）。计算每组的息肉样病变数量，并与 ICGA 进行比较。
本研究共纳入 94 例 AMD 患者的 94 只眼，其中 66.0%为男性，平均年龄为 71.8±9.0 岁。使用 ICGA 的 PCV 诊断率为 45.7%。A 组的敏感性为 0.88，B 组为 0.93，特异性分别为 0.94 和 0.96。AUC 分别为 0.90（95%置信区间[CI]，0.83-0.97）和 0.96（95%CI，0.90-1.00）。A 组检测到 1.28±0.91 个息肉样病变，B 组检测到 1.47±1.01 个，ICGA 检测到 1.51±0.86 个。
本研究强调，在不使用 ICGA 的情况下，CFP 联合 OCT 和 CFP 联合 SS-OCTA 对诊断 PCV 均具有较高的敏感性、特异性和 AUC。SS-OCTA 有助于提高 PCV 诊断的敏感性、特异性和 AUC。
