IOLMaster 700对白内障术前患者黄斑疾病的筛查价值

IOLMaster 700 for screening macular diseases in patients before cataract surgery

目的探讨基于SS-OCT技术的生物测量仪IOLMaster 700对白内障术前患者进行黄斑疾病的筛查价值。方法横断面研究。收集2018年12月就诊于首都医科大学附属北京同仁医院白内障门诊的白内障术前患者208例(312眼),用IOLMaster 700进行生物测量,该设备可通过SS-OCT技术提供1 mm的黄斑中心凹水平扫描图像。所有患者同时行频域光学相干断层扫描(SD-OCT)确定黄斑情况。记录两种检查方法黄斑是否存在病变并记录病变类型,以SD-OCT的结果为标准,计算IOLMaster 700检测黄斑疾病的灵敏度、特异度、假阳性率、假阴性率、一致率、阳性及阴性预测值、阳性及阴性似然比,并绘制ROC曲线。结果本研究共纳入患眼262眼,排除50眼,其中115眼患有黄斑疾病(43.9%),147眼正常(56.1%)。IOLMaster 700与SD-OCT比较Kappa值为0.52(95%CI 0.42~0.62),说明有中高度一致性(P<0.001)。IOLMaster 700筛查黄斑疾病的灵敏度为56.5%,特异度为93.2%,假阳性率为6.8%,假阴性率为43.5%,一致率为77.1%,阳性预测值为86.7%,阴性预测值为73.3%,阳性似然比为8.31,阴性似然比为0.47,ROC曲线下面积为0.75。其中,诊断黄斑裂孔、黄斑水肿的准确性较高,对于非中心凹处的玻璃体后脱离、黄斑前膜、黄斑劈裂、神经上皮脱离、黄斑退行性改变、玻璃膜疣,IOLMaster 700筛查时容易漏诊。结论IOLMaster 700可以作为白内障术前筛查是否存在黄斑疾病的工具,但因扫描范围小且图像质量有限,因此不能完全取代SD-OCT检查。

Objective To study the value of IOLMaster 700 based on swept-source optical coherence tomography for screening macular disease before cataract surgery.Methods Cross-sectional study.A total of 208 consecutive patients(312 eyes)scheduled for cataract surgery in Beijing Tongren Hospital were collected in December 2018.The biometry examination was performed with IOLMaster 700,which can provide a 1mm horizontal scan of the fovea by swept-source optical coherence tomography(SS-OCT)technology.All patients underwent spectral-domain optical coherence tomography(SD-OCT)to determine the macular condition.Based on the SD-OCT results,we calculated the sensitivity,specificity,false positive rate,false negative rate,agreement rate,positive and negative prediction value,positive and negative likelihood ratio with IOLMaster 700 and drew the ROC curve.Results There were 262 eyes included in this study,and 50 eyes were excluded.Among them,115 eyes had macular disease(43.9%)and 147 eyes were normal(56.1%).Compared with SD-OCT,IOLMaster 700 had a kappa value of 0.52(95%CI 0.42-0.62),indicating a medium to high degree of agreement(P<0.001).The sensitivity of screening macular diseases was 56.5%for IOLMaster 700,and the specificity was 93.2%,the false positive rate was 6.8%,the false negative rate was 43.5%,the agreement rate was 77.1%,the positive predictive value was 86.7%,and the negative predictive value was 73.3%,the positive likelihood ratio was 8.31,the negative likelihood ratio was 0.47,and the area under the ROC curve was 0.75.In general,the accuracy of diagnosing macular hole and macular edema was high.However,the non-central diseases,including posterior vitreous detachment,epiretinal membrane,macular splitting,neuroepithelial detachment,macular degeneration,drusen,tended to be missed by IOLMaster 700.Conclusion IOLMaster 700 can be used for screening macular disease before cataract surgery,but due to the limited scanning range and image quality,it cannot completely replace the SD-OCT examination.