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A. Tarantini, M. Pala, F. Menchini, G. Virgili, P. Lanzetta, F. Bandello, G. Polini; Optical Coherence Tomography versus Fluorescein Angiography for Diagnosing and Treating Neovascular Age-Related Macular Degeneration: A Sistematic Review. Invest. Ophthalmol. Vis. Sci. 2008;49(13):885. doi: https://doi.org/.
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To systematically review the sensitivity and specificity of optical coherence tomography (OCT) for diagnosing and managing neovascular age-related macular degeneration (AMD) as compared to well-established gold standard test such as fluorescein angiography.
We searched Medline, from 1966 to 2007. Two reviewers independently assessed trial searches, studied quality with the QUADAS checklist and extracted data. The target disease was neovascular AMD. A bivariate model was used to obtain summary estimates of sensitivity and specificity and fit a summary receiver operating characteristic (ROC) curve.
Seven studies were considered eligible. These studies were of good quality for most items of the QUADAS checklist, but most studies did not report masking of examiners and did not describe how withdrawals and undetermined results were treated. Sensitivity and specificity data could be extracted from 5 out of 7 studies because appropriate cross-tabulations of index and reference tests were not reported by the others. One of these studies assessed the performance of OCT to confirm or exclude the diagnosis in patient with suspect CNV; the prevalence of CNV in these patients was 64%, the sensitivity was 96% and the specificity was 66%, if OCT was coupled with stereoscopic fundus photography the performance improved. Four studies assessed the ability of OCT to diagnose the need for retreatment in patients that were previously treated with PDT, in these the sensitivities varied between 65 % and 100%, the specificities varied between 43% and 80%. The result were too heterogeneous to conduct a metanalysis and draw conclusions for clinical practice.
Optical coherence tomography is a valid tool for diagnosing neovascular AMD compared to fluorescein angiography; this conclusion was supported by only one study with high pre-test probability so the result cannot be apply in a screening setting. The various OCT criteria, combined or alone, do not correlate well with leakage on FA when assessing the need for PDT retreatment during follow up, particularly the specificity is low.
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