Diagnostic accuracy of disorganization of the retinal inner layers in detecting macular capillary non-perfusion in diabetic retinopathy

作者：Nicholson Luke; Ramu Jayashree; Triantafyllopoulou Ioanna; Patrao Namritha V; Comyn Oliver; Hykin Philip; Sivaprasad Sobha

来源：Clinical and Experimental Ophthalmology, 2015, 43(8): 735-741.

DOI：10.1111/ceo.12557

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Disorganization of the retinal inner layers (<jats:styled-content style="fixed-case">DRIL</jats:styled-content>) on optical coherence tomography (<jats:styled-content style="fixed-case">OCT</jats:styled-content>) is thought to represent retinal capillary non‐perfusion (<jats:styled-content style="fixed-case">CNP</jats:styled-content>) in eyes with diabetic retinopathy. This study was designed to evaluate the ability of <jats:styled-content style="fixed-case">DRIL</jats:styled-content> to accurately predict <jats:styled-content style="fixed-case">CNP</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective masked reliability and diagnostic accuracy study performed in the National Institute for Health Research (NIHR) <jats:styled-content style="fixed-case">M</jats:styled-content>oorfields <jats:styled-content style="fixed-case">B</jats:styled-content>iomedical <jats:styled-content style="fixed-case">R</jats:styled-content>esearch <jats:styled-content style="fixed-case">C</jats:styled-content>entre, <jats:styled-content style="fixed-case">L</jats:styled-content>ondon, <jats:styled-content style="fixed-case">UK</jats:styled-content></jats:p></jats:sec><jats:sec><jats:title>Samples</jats:title><jats:p>Retinal images of patients with diabetic retinopathy</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The <jats:styled-content style="fixed-case">OCT</jats:styled-content> images from 90 separate areas of angiographically confirmed perfused and non‐perfused areas of the macula from 37 eyes of 31 patients were anonymized and coded. Two masked graders independently graded these <jats:styled-content style="fixed-case">OCT</jats:styled-content> scans for the presence or absence of <jats:styled-content style="fixed-case">DRIL</jats:styled-content> to determine the intergrader reliability. The diagnostic accuracy of <jats:styled-content style="fixed-case">DRIL</jats:styled-content> in identifying <jats:styled-content style="fixed-case">CNP</jats:styled-content> was evaluated from the results obtained.</jats:p></jats:sec><jats:sec><jats:title>Main Outcome Measures</jats:title><jats:p>Sensitivity and specificity of <jats:styled-content style="fixed-case">DRIL</jats:styled-content> in accurately detecting <jats:styled-content style="fixed-case">CNP</jats:styled-content></jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The intergrader agreement was high with a <jats:styled-content style="fixed-case">C</jats:styled-content>ohen's <jats:styled-content style="fixed-case">k</jats:styled-content>appa of 0.909. <jats:styled-content style="fixed-case">DRIL</jats:styled-content> was present in 84.4% (38/45) of non‐perfused retina and none in perfused retina (0/45). The sensitivity and specificity of <jats:styled-content style="fixed-case">DRIL</jats:styled-content> in detecting angiographic evidence of <jats:styled-content style="fixed-case">CNP</jats:styled-content> was 84.4% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 86.5%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The presence of <jats:styled-content style="fixed-case">DRIL</jats:styled-content> is a reliable predictor of areas of macular <jats:styled-content style="fixed-case">CNP</jats:styled-content>. However, <jats:styled-content style="fixed-case">DRIL</jats:styled-content> is not a universal finding of non‐perfusion, with some cases exhibiting absence of <jats:styled-content style="fixed-case">DRIL</jats:styled-content> despite angiographic <jats:styled-content style="fixed-case">CNP</jats:styled-content>.</jats:p></jats:sec>

• 出版日期2015-11