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L. M. Pierro, M. Gagliardi, S. Giatsidis, E. Mantovani, E. Zampedri, U. Introini, M. Setaccioli, F. Scotti; Spectral Domain OCT (SDOCT) versus Fluorescein Angiography (FA) in Wet Age Macular Degeneration (AMD) Evaluation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5254.
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FA is used to evaluate leakage in neovascular macular diseases. However, FA cannot visualize intra, sub and epiretinal structures at their exact morphologic level. SDOCT, thanks to its high resolution and scan velocity, permits the visualization and examination of intraretinal macular edema (IME), pigment epithelium detachment (PED), neurosensory retina detachment (NSRD) and epiretinal membrane (EM). A study was performed to compare FA to SDOCT for the evaluation of morphologic changes in patients with wet AMD having undergone AVEGF treatment either alone or combined with PDT. The possibility for re-treatment was also evaluated.
a retrospective study was performed on 62 eyes with treated AMD using OCT/SLO (OPKO Health INC.) and FA (TOPKON TRC-50 DX). Two masked operators evaluated macular features using SDOCT and FA. The following SDOCT parameters were considered: IME, PED, NSRD, EM. FA parameters were as follows: PED and the presence of leakage. Leakage was compared with IME and NSRD both singularly and combined. The possibility for re-treatment was evaluated on the basis of the results obtained. The level of agreement between the two evaluations was quantified by kappa measure of agreement. The Chi-square was used to evaluate links between the parameters obtained using the two tools.
PED: K value 0.09; IME versus leakage: K value 0.04; NSRD versus leakage: K value 0.08; IME+NSRD versus leakage: K value 0.08. Using SDOCT we observed EM in 50% of patients with IME (p=0.009). Considering only patients with EM, agreements were as follows. IME versus leakage: K value 0.29; NSRD versus leakage: K value 0.05; IME+NSRD versus leakage: K value 0.15. Re-treatment decision presented a fair agreement between the two tools despite the other parameters: K value 0.29.
The agreement between all the parameters using with the two tools was very poor.However, when selecting patients with EM the agreement between leakage and IME increased. Re-treatment decisions presented fair agreement. Patients with wet AMD and EM, observed using SDOCT ,need more attention in the interpretation of FA images for re-treatment decisions.
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