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L. Akduman, M. Jones, B. Talley, B. Kaderli; Optical Coherence Tomography (OCT) Enhances the Accuracy of Clinical Diagnosis in Macular Disorders . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4030.
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© ARVO (1962-2015); The Authors (2016-present)
To review the type and incidence of missed or misdiagnosed macular disorders which are later confirmed with Optical Coherence Tomography (OCT).
Charts of 100 consecutive patients who on their initial visits received OCT as part of their workup were retrospectively reviewed. Data collection included the reason(s) for ordering OCT (pre–OCT diagnosis) and the diagnosis given after the OCT was reviewed (post–OCT diagnosis). The type and incidence of missed or misdiagnosed macular disorders which are later confirmed with OCT were noted.
One–hundred–sixty–two eyes of 100 patients were included in the review. Seven eyes had more than one pre–OCT diagnoses for which OCT was ordered. Therefore, 169 pre–OCT diagnoses were compared with post–OCT diagnoses. Pre–OCT diagnoses were cystoid macular edema (CME) in 18.3%; clinically significant diabetic macular edema (CSDME) in 17.2%; macular pucker in 10.7%; non–proliferative diabetic retinopathy without CSDME in 8.28%; macular hole in 7.10%; age related macular degeneration (AMD) in 5.32%; choroidal neovascular membrane from non–AMD causes in 3.55%; proliferative diabetic retinopathy without CSDME in 1.77%; pigment epithelial detachment in 1.77%; uveitis with poor view of posterior pole 1.77%; taut posterior hyaloid in 1.77%; nonspecific RPE changes in 1.18%; macular ischemia in 1.18%; choroidal rupture, myopic degeneration, lipid exudate, and serous retinal detachment were found in single occurances each; and fellow eyes with no pre–OCT clinical finding in 17.7% of the occasions. There were unexpected findings (a post–OCT diagnosis that did not match the pre–OCT diagnosis) in 17 occasions (10.1%). The diagnoses that changed after the OCT included: over–diagnosis of CME in 4 occasions (12.9%), over–diagnosis of CSDME in 4 occasions (13.9%), 2 "normal" fellow eyes having CME (6.67), and one "normal" fellow eye having stage Ia macular hole (3.33%).
Clinical examination without OCT can be misleading in accurately diagnosing the presence and extent of the macular diseases in approximately ten percent of the cases. OCT is an invaluable adjunct in retinal practice for the diagnosis and management of these patients.
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