Sykes S O, Bressler N M, Maguire M G, Schachat A P, Bressler S B
Retinal Vascular Center, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Md.
Arch Ophthalmol. 1994 Dec;112(12):1561-6. doi: 10.1001/archopht.1994.01090240067027.
OBJECTIVE/DESIGN: To evaluate prospectively the ability of three retina specialists to detect recurrent choroidal neovascularization (CNV) after clinical examination alone and then with fluorescein angiography at 3 and 6 weeks and at 3, 6, 9, and 12 months after laser photocoagulation.
Single tertiary retinal referral center.
All patients who had laser treatment for CNV within 14 months of their study visit. One hundred thirty-seven eyes of 134 patients were evaluated during 401 visits.
Sensitivity, specificity, positive predictive value, and negative predictive value of clinical examination with biomicroscopy to detect recurrent CNV when defined as leakage on the periphery of the laser-treated area on the fluorescein angiogram.
Ninety-seven definite or probable recurrences in 56 eyes were identified on the fluorescein angiogram. Clinical examination had a sensitivity of 59%, specificity of 94%, positive predictive value of 76%, and negative predictive value of 88%. These figures varied somewhat by underlying cause, age, time since treatment, and lesion location. Using either a reported or measured loss of vision with the results of biomicroscopy as an indication of recurrence increased the sensitivity to 77% but reduced the specificity to 81%.
Clinical examination probably cannot replace fluorescein angiography in detecting all recurrent CNV after laser treatment. However, for follow-up visits in which recurrent CNV was not suspected on biomicroscopy, definite or questionable recurrent CNV was identified on the fluorescein angiogram only 12% of the time, while the absence of recurrent CNV using this method was confirmed 88% of the time.
目的/设计：前瞻性评估三位视网膜专家仅通过临床检查，以及之后在激光光凝治疗后3周和6周、3个月、6个月、9个月及12个月时通过荧光素血管造影检测复发性脉络膜新生血管（CNV）的能力。
单一的三级视网膜转诊中心。
所有在研究访视前14个月内接受过CNV激光治疗的患者。在401次访视期间对134例患者的137只眼进行了评估。
当将复发性CNV定义为荧光素血管造影显示激光治疗区域周边渗漏时，通过生物显微镜进行临床检查检测复发性CNV的敏感性、特异性、阳性预测值和阴性预测值。
在荧光素血管造影上，56只眼中发现了97例明确或可能的复发。临床检查的敏感性为59%，特异性为94%，阳性预测值为76%，阴性预测值为88%。这些数值因潜在病因、年龄、治疗后时间及病变位置而有所不同。将报告的或测量的视力丧失与生物显微镜检查结果作为复发的指标，可将敏感性提高至77%，但特异性降至81%。
在检测激光治疗后的所有复发性CNV方面，临床检查可能无法替代荧光素血管造影。然而，对于生物显微镜检查未怀疑复发性CNV的随访，荧光素血管造影仅在12%的时间内发现明确或可疑的复发性CNV，而使用此方法未发现复发性CNV的情况在88%的时间内得到证实。
