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Eileen S Hwang, Jessica A Kraker, Kim J Griffin, J Sebag, Judy E Kim; Accuracy of Macular Optical Coherence Tomography in Diagnosing Posterior Vitreous Detachment. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1855. doi: https://doi.org/.
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Vitreomacular adhesion has been associated with disease severity, prognosis, and treatment response in vitreo-maculopathies, diabetic retinopathy and exudative age-related macular degeneration. The accuracy of macular spectral domain optical coherence tomography (sdOCT) in determining posterior vitreous detachment (PVD) status was evaluated in a retrospective, comparative study.
PVD status on preoperative macular sdOCT performed ≤ 90 days before surgery was compared to intraoperative presence or absence of pre-vitrectomy PVD. Inclusion criteria were definitive declaration of vitreous status in the operative report and sdOCT of adequate image quality and position. Twelve 6mm radial fovea-centered scans were obtained using Heidelberg Spectralis. A single masked investigator (ESH) evaluated scans of 182 eyes in 182 patients (111 female, 71 male), with a mean age of 66 years. The most common diagnoses were macular hole (MH; 49%), premacular membrane with pucker (PMM/pucker; 28%) and proliferative diabetic retinopathy (13%). Attached vitreous was identified on sdOCT by visualizing the posterior vitreous cortex or the premacular bursa. Complete PVD was identified by the absence of these 2 features.
At surgery, preoperative PVD was present 4 times more frequently in PMM/pucker than MH (p<0.0001), confirming previous studies. At surgery in the entire group, 36/182 eyes (19.8%) had pre-existing PVD: 33 graded as complete PVD on sdOCT (true positives, sensitivity = 92%) and 3 graded as attached (false negatives). Of the 146 eyes with attached vitreous at surgery, 125 were graded as attached vitreous on sdOCT (true negatives, specificity = 86%), and 21 were graded as complete PVD (false positives). The positive predictive value (PPV) for diagnosing PVD was 61% and the negative predictive value (NPV) was 98%. In eyes with MH, sensitivity=89%, specificity=91%, PPV=53% and NPV=99%. In eyes with PMM/pucker, sensitivity=95%, specificity=71%, PPV=68% and NPV=96%.
If the premacular bursa or posterior vitreous cortex are visualized on macular sdOCT, an accurate determination of attached vitreous can be made (NPV = 99% for MH & 96% for PMM/pucker). The diagnosis of complete PVD by macular sdOCT is less accurate, suggesting that when the premacular bursa and posterior vitreous cortex cannot be visualized, ultrasound may be required to make an accurate determination of vitreous status.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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