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Ramin Tadayoni, Vincent Gualino, Salomon Cohen, Gabriel Quentel, Belkacem Haouchine, Ali Erginay, Pascale Massin, Eric Vicaut, Alain Gaudric, ESSO Group; Optical Coherence Tomography and fluorescein angiography in the diagnosis of choroidal neovascularization of age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6288.
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To determine the sensitivity and specificity of different retinal imaging combinations for the diagnosis of choroidal neovascularization (CNV) of age-related macular degeneration (AMD).
In a prospective observational study, 149 patients over 50 years with suspected, untreated, recent CNV related to AMD, were consecutively included in two different centers. Only data collected during the first visit were used: best-corrected visual acuity (VA), color fundus photographs (CFP), fluorescein angiography (FA), and spectral domain optical coherence tomography (OCT). OCT included a macular cube (128 lines x 512 pixels), and 5 horizontal and vertical raster lines separated by 75 microns and centered on the macula. After the end of inclusions and randomization, 5 retina specialists read the images without interfering in the management of patients. Three sets of images were read separately: set 1 comprising OCT+CFP of each case, set 2 comprising FA+CFP, and set 3 comprising OCT+FA+CFP+VA. The reference diagnosis of each case was obtained by consensus of several readers with access to all data of each case (OCT+ FA+CFP+VA). The Study adhered to the tenets of the Declaration of Helsinki. ClinicalTrials.gov Identifier: NCT01080898.
149 patients (mean age 78.7 years old) were included, of whom 111 had a CNV. The CNV was classic in 22.5% of cases, occult in 36% of cases, and the remaining, called here "other CNV", included mixed CNV, polyppoidal CNV, and choroidal anastomoses. For the diagnosis of CNV, the sensitivity of OCT+CFP, FA+CFP and OCT+FA+CFP+VA were respectively 91%, 90.5% and 96.8% and their specificity respectively 87.7%, 88.2% and 93.4%. Classic CNV were diagnosed in 98-100% of cases with OCT+CFP or FA+CFP, when occult CNV were diagnosed in 82% of cases with each of these combinations. The “other CNV” cases were properly diagnosed in 93.8% of cases with each combinations. The interrater reproducibility of OCT+CFP and FA+CFP were very good with respectively kappa = 0.80 and 0.74.
: When used as the first diagnostic test, OCT or FA, combined with CFP, have similar sensitivity and specificity for the diagnosis of CNV of AMD. OCT+CFP or FA+CFP are able to diagnose properly CNV in about 90% of cases. Combination of OCT+FA+CFP+VA increases this rate by about 6%. Most errors with any of theses combinations concern occult CNV.
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