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Mayer Srour, Julien Tilleul, Nathalie Massamba, Farah Ghardaoui, Elise Boulanger-Scemama, Franck Lalloum, Giuseppe Querques, Eric H Souied; Evaluation of imaging examinations for decision of retreatment in exudative age related macular degeneration.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3955.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the sensitivity and specificity of retreatment decision with different combinations among best corrected visual acuity (BCVA), spectral-domain optical coherence tomography (SD-OCT), SD-OCT with real-time eye-tracking technology and fluorescein angiography (FA) in exudative age-related macular degeneration (AMD).
We conducted a prospective study with 102 patients treated by intravitreal injections of ranibizumab on a pro-re-nata (PRN) basis and followed for at least 6 months. Retreatment decision was analyzed at each stage of the review, sequentially. We analyzed treatment decision guided by BCVA alone, BCVA combined with SD-OCT, BCVA combined with SD OCT real-time eye-tracking technology compared to BCVA combined with SD-OCT real-time eye-tracking technology and fluorescein angiography (FA). BCVA combined with SD OCT real-time eye-tracking technology plus FA was considered as the reference, giving the final decision.
BCVA as only criteria for retreatment decision showed a sensitivity of 57.1 % (95% CI: 42.2- 70.8) and a specificity of 71.7 % (95% CI: 59.2-81.4) in taking the final decision. BCVA plus SD-OCT as criteria for retreatment showed a sensitivity of 90.5 % (95% CI: 77.9-96.2) and a specificity of 93.4% (95% CI: 86.3-98.2). BCVA plus SD-OCT real-time eye-tracking technology as criteria for retreatment showed a sensitivity of 95.2 % (95% CI: 80.9-97.5) and a specificity of 100% (95% CI: 93.9-100).
We demonstrate that evaluation of BCVA changes alone is not sensitive enough to indicate disease recurrence, while BCVA plus SD-OCT with real-time eye-tracking technology is the best noninvasive combination for treatment decision in patients with exudative AMD. We suggest that FA should be performed in order to confirm the presence or absence of CNV activity only in case of doubtful SD-OCT findings.
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