Impact of optical coherence tomography on surgical decision making for epiretinal membranes and vitreomacular traction
Impact of optical coherence tomography on surgical decision making for epiretinal membranes and vitreomacular traction
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DOI：
10.1097/iae.0b013e31802c518b
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发表时间：
2007-06-01
影响因子：
3.3
通讯作者：
Haller, Julia A.
中科院分区：
文献类型：
--
作者：
Do, Diana V.;Cho, Minhee;Haller, Julia A.
目的：为了比较视网膜外科医生的建议，管理视网膜前膜（ERM）和玻璃体黄斑牵引（VMT）的基础上，单独的临床评估与管理的基础上，补充了光学相干断层扫描（OCT）。方法：前瞻性，掩蔽的临床病例系列进行。外科医生首先对研究中的黄斑疾病患者进行完整的病史和体格检查，确定是否存在、可疑存在或不存在ERM、VMT和/或黄斑水肿，并提出临时管理建议。视网膜专家，然后审查了OCT图像的存在或不存在的ERM，VMT，和/或相关的黄斑水肿，并重新考虑了最终的管理建议，结合OCT findings.Results的临床评价：84眼的73例患者进行了检查。使用临床检查的84只眼中有66只（78.6%）确定了ERM，而使用OCT的84只眼中有72只（85.7%）确定了ERM（P = 0.06）。临床检查发现VMT者5例（6%），OCT检查发现VMT者18例（21.4%）（P < 0.005）。使用临床检查的84只眼中有57只（67.9%）发现黄斑水肿，而使用OCT的84只眼中有70只（83.3%）发现黄斑水肿（P = 0.003）。33例建议手术干预：19例（57.6%）的基础上的历史和临床检查结果没有OCT信息和一个额外的14（42.4%）的基础上结合临床评估和OCT findings.Conclusions：OCT是更敏感的检测ERM，VMT，和相关的黄斑水肿比临床检查。结合仔细的临床评价，OCT结果影响外科医生建议对该系列中另外14例患者（42.2%）考虑手术。
Purpose: To compare retina surgeons' recommendations for management of epiretinal membranes (ERM) and vitreomacular traction (VMT) based on clinical assessment alone with management based on clinical evaluation supplemented by optical coherence tomography (OCT).Methods: A prospective, masked clinical case series was conducted. Surgeons first performed a complete history and physical examination on patients referred with the macular disorders under study without the benefit of adjunctive OCT, determined whether ERM, VMT, and/or macular edema were present, questionably present, or absent, and made a provisional management recommendation. The retina specialists then reviewed the OCT images for the presence or absence of ERM, VMT, and/or associated macular edema and reconsidered the final management recommendation in light of clinical evaluation combined with OCT findings.Results: Eighty-four eyes of 73 patients were examined. ERM was identified in 66 (78.6%) of 84 eyes using clinical examination compared with 72 (85.7%) of 84 eyes using OCT (P = 0.06). VMT was identified in 5 (6%) of 84 eyes using clinical examination compared with 18 (21.4%) of 84 eyes using OCT (P < 0.005). Macular edema was identified in 57 (67.9%) of 84 eyes using clinical examination compared with 70 (83.3%) of 84 eyes using OCT (P = 0.003). Surgical intervention was recommended in 33 cases: 19 (57.6%) based on the history and clinical examination findings without OCT information and an additional 14 (42.4%) based on the combination of clinical evaluation and OCT findings.Conclusions: OCT is more sensitive than clinical examination in detecting ERM, VMT, and associated macular edema. Taken together with careful clinical evaluation, OCT findings influenced surgeons to recommend consideration of surgery to an additional 14 patients (42.2%) in this series.