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John H. Kempen, Elizabeth A. Sugar, Nisha Acharya, James P. Dunn, Jr., Susan G. Elner, Glenn J. Jaffe, Susan L. Lightman, Jennifer E. Thorne, Albert T. Vitale, Michael M. Altaweel; Diagnosis of Macular Edema in Patients with Uveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6564.
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Diagnosis of macular edema (ME) is a high priority in uveitis. We compared methods of diagnosing ME in eyes of Multicenter Uveitis Steroid Treatment (MUST) Trial participants, who had active or recently active intermediate, posterior or panuveitis.
Eyes were assessed for ME by Reading Center gradings of stereo fluorescein angiograms (FA) and Stratus OCT-3 Fast Macular Thickness scans (OCT) obtained at the same visit. Macular thickening (MT) was defined as retinal thickness ≥240 µm by OCT and macular leakage (ML) was defined by the presence of leakage on FA in the central macula. Kappa (Κ) and McNemar’s test (MNT), and predictive probabilities assessed agreement between methods.
Among 481 eyes with uveitis (255 patients), OCT and FA images were collected and graded for 90% and 76% of eyes, respectively (p<0.001). Agreement between MT by OCT and ML by FA was modest (Κ = 0.36). The disagreement was driven primarily by the presence of ML in eyes without MT (MNT: p < 0.01). Only 50% of eyes with ML had MT, and 55% of eyes without MT had ML. Eyes with MT were likely to have ML (87%) and eyes without ML were unlikely to have MT (89%). Nineteen eyes had only non-central ML (4 with MT, 15 without MT); excluding these slightly improved agreement (Κ = 0.42) and the percentage of eyes with ML that had MT (53%), but slightly decreased the fraction of eyes with MT that had ML (84%).
Macula assessment was accomplished more frequently via OCT than FA. The two methods often disagree in diagnosing ME. To the extent that MT (an anatomic entity) and ML (more of a physiologic entity) actually differ, OCT and FA may offer complementary clinical information in a large minority of cases similar to those studied (particularly cases without MT or with ML).
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