Variability of panretinal photocoagulation lesions across physicians and patients. Quantification of diameter and intensity variation
Variability of panretinal photocoagulation lesions across physicians and patients. Quantification of diameter and intensity variation
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DOI：
10.1007/s00417-016-3416-9
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发表时间：
2017-01-01
影响因子：
2.7
通讯作者：
Koinzer, Stefan
中科院分区：
文献类型：
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作者：
Saeger, Mark;Heckmann, Jan;Koinzer, Stefan
光凝损伤强度依赖于视网膜漂白的判断。病变变成可变的，由于过度依赖的判断和时间依赖性的漂白。我们调查了临床常规治疗中每位患者和每位医生的病变变异性。在这项观察性临床试验中，不同的医生对糖尿病视网膜病变进行了全视网膜光凝。研究眼在20 ms（3名医生，9只眼）和200 ms（4名医生，12只眼）照射时间（532 nm连续波光凝固器，300 μ m光斑尺寸）下接受20 - 30个研究损伤。1小时后，用摄影和光学相干断层扫描（OCT）对病变进行成像。我们测量了眼底和OCT图像中的病变直径，并根据先前发表的六步分类器对强度进行分级。200 ms病变比20 ms病变（397，347 - 459 μ m，主要为3 - 4级）更大，更严重（568，474 - 625 μ m [中位数，IQR]，主要为6级）。与其他因素相比，激光功率的影响较小。眼底和OCT图像中的病变强度和直径在患者之间和医生之间存在显著差异。在本研究中，对于给定的斑点数量，视网膜治疗面积的变化高达1.61（2）= 2.59。由于临床疗效取决于治疗面积，这是病变数量与每处病变面积的函数，我们的结果表明，如果仅根据病变数量或间距进行治疗，则总体治疗效果控制不佳。应寻求更好的激光效应控制方法。
Photocoagulation lesion intensity relies on the judgement of retinal blanching. Lesions turn out variable due to observer-dependent judgement and time dependency of blanching. We investigated lesion variability per patient and per physician in clinical routine treatments.In this observational clinical trial, different physicians performed panretinal photocoagulation for diabetic retinopathy. Study eyes received 20-30 study lesions at 20 ms (three physicians, nine eyes) and 200 ms (four physicians, 12 eyes) irradiation time (532 nm continuous wave photocoagulator, 300 mu m spot size). Lesions were imaged after 1 hour with photography and optical coherence tomography (OCT). We measured lesion diameters in fundus and OCT images, and graded intensities according to a previously published six-step classifier.200-ms lesions were larger and more severe (568, 474-625 mu m [median, IQR], predominantly class 6) than 20-ms lesions (397, 347-459 mu m, predominantly classes 3-4). The impact of laser power was small compared to other factors. Lesion intensities and diameters in fundus and OCT images varied significantly between patients and between physicians. Median photographic lesion diameters varied by up to a factor of 1.61 (20 ms) or 1.5 (200 ms) respectively.In this study, the treated area of retina varied by up to a factor of 1.61(2) = 2.59 for a given spot number. As clinical efficacy depends on the treated area, which is a function of lesion number by area per lesion, our results implicate poor control of the overall treatment effect if treatments are administered according to lesion number or spacing alone. Better ways of laser effect control should be sought.