黄斑水肿不同诊断方法的比较

A comparative study of various diagnostic procedures in macular edema

目的探讨海德堡视网膜断层扫描仪(HRT-Ⅱ)和相于光断层扫描仪(OCT)对黄斑水肿的诊断价值。方法对荧光素眼底血管造影(FFA)确诊的212只眼,分别应用HRT-Ⅱ测定黄斑区水肿指数值(E值),应用OCT测定黄斑中心凹视网膜厚度值。再用HRT-Ⅱ和OCT分别进行黄斑水肿定量诊断,并将其检测结果与FFA诊断结果进行一致性比较。结果以FFA检测结果作为金标准,分别与其他两种方法比较,得到黄斑水肿诊断的Kappa值:OCT为0．553,HRT-Ⅱ为0．403。黄斑水肿诊断的优势比(OR值):OCT为8．519,HRT-Ⅱ为3．210。经FFA诊断的黄斑水肿组与无黄斑水肿组患者,再应用HRT-Ⅱ检测黄斑水肿指数,两组间比较差异有统计学意义(P<0.01);而OCT检测的两组黄斑视网膜厚度值比较,差异亦有统计学意义(P<0．01)。HRT-Ⅱ检测黄斑水肿正常值的最佳临界值为E=2．00,ROC曲线面积为0．673。OCT诊断黄斑水肿的视网膜厚度最佳临界值为170μm,ROC曲线面积为0．774。结论对于黄斑水肿的诊断,HRT-Ⅱ灵敏度较OCT高,漏诊率低,但特异性差,误诊率较高。对于黄斑水肿的定位观察,HRT-Ⅱ具有明显优势。OCT对黄斑水肿的诊断结果与FFA相比,其一致性好于HRT-Ⅱ。OCT对黄斑水肿的临床诊断价值高于HRT-Ⅱ。两种检查手段相结合可以准确进行黄斑水肿的定量分析。

Objective To compare the results for diagnosis of macular edema between Heidelberg retina tomography （ HRT- Ⅱ macular edema module ） and optical coherence tomography （OCT）. Methods Two hundred and twelve eyes of 106 macular edema patients were diagnosed with fundus fluorescein angiography （FFA）. HRT-Ⅱ was used to obtain Edema Index and OCT was used to measure the retina thickness in the fovea. The results were compared with FFA. Results As FFA for gold standard, we compared with other diagnosis method. With regard to the diagnosis of macular edema by OCT, the Kappa value was 0.553, the odds ratio （OR） was 8. 519. The Kappa value of HRT- Ⅱ was 0. 403 and OR was 3. 210. In two groups of patients with and without macular edema, which were diagnosed by FFA, the difference of Macular edema Index P assayed by HRT- Ⅱ between these two groups was significant （ P = 0. 00） ; while the difference of fovea retina thickness P assayed by OCT between these two groups was significant, too （P=0.00）. The best critical value of E was 2.00 and the ROC curve＇s area was 0.673 in the detection of macular edema by HRT- Ⅱ. The best critical value of retina thickness for the diagnosis of macular edema was 170 μm and the ROC curve＇s area was 0. 774 in the detection of macular edema by OCT. Conclusions In regard to the diagnosis of macular edema, the sensitivity of HRT- Ⅱ is better than that from OCT, with a lower false-negative result. However, HRT-Ⅱ has a relatively low specialty with a higher false- positive result. As for the localization of macular edema, HRT- Ⅱ has its advantage. Compared with FFA, the consistence of OCT for the diagnosis of macular edema is better than that of HRT- Ⅱ . We can conclude from the OR value that OCT has greater influence than HRT-Ⅱ in the diagnosis of macular edema. In addition, as for the diagnosis and different diagnosis, the clinical value of OCT is higher than that of HRT-Ⅱ. Combination of these two different diagnostic methods might provide an accurate quantitative analysis of macular edema. （Chin J Ophthalmol , 2006,42：724-727）