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Polypoidal choroidal vasculopathy- can SD-OCT overtake indocyanine-green angiography?

Session Details

Session Title: AMD II

Session Date/Time: Friday 12/09/2014 | 08:00-10:00

Paper Time: 09:28

Venue: Boulevard D

First Author: : J.Marques PORTUGAL

Co Author(s): :    I. Laíns   J. Figueira   C. Farinha   M.L. Cachulo   M. Costa   R. Silva

Abstract Details

Purpose:

To determine the sensitivity and specificity of polypoidal choroidal vasculopathy (PCV) diagnosis without indocyanine-green angiography (ICGA). To establish the main optical coherence tomography (OCT) features related with a correct diagnosis.

Setting:

Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal. Associação para a Investigação Biomédica e Inovação em Luz e Imagem (AIBILI), Coimbra, Portugal

Methods:

A review of the medical records of our local database was performed by one of the authors. Consecutive patients with newly diagnosed PCV or occult choroidal neovascularization (CNV) were identified. PCV diagnosis was assumed when PCV lesions were recognizable on ICGA. Only treatment-naive eyes with baseline color fundus photographs, OCT, fluorescein angiography (FA) and ICGA were included. Baseline images were collected and organized by patient, blinding any identifying features. All the images but ICGA were then provided to three Ophthalmologists who independently evaluated each case according to a standardized database.

Results:

One-hundred eyes were included, 53 occult CNV and 47 PCV. Twenty-nine percent had available Spectralis® HRA+OCT and the remaining had Cirrus® HD-OCT. Thirty-two of the 47 PCV cases were identified when considering an agreement between ≥2 graders, which represents a sensitivity of 68.09% (95% CI 55.88; 80.91) and a specificity of 56.60% (95% CI 42.28; 70.16). Regarding individual results only, sensitivity and specificity significantly varied with grader’s experience. Availability of Spectralis® OCT was positively associated with an accurate diagnosis (p=0.010). OCT findings that were most significantly associated with a correct diagnosis of PCV were the identification of subfoveal (p=0.05) and extrafoveal polypoidal lesions (p=0.001) and a notch at the margin of serous retinal pigment epithelium detachments (p=0.034). Identification of these features was associated with an accurate diagnosis of PCV by the graders (positive predictive value of 100% for all).

Conclusions:

To our knowledge, this was the first study designed to evaluate the accuracy of PCV diagnosis without the concomitant use of ICGA. It revealed a good sensitivity and specificity. Graders' experience and the type of available OCT seem to be determinant factors. Ophthalmologists should be trained to identify the OCT features with the higher positive predictive rates.

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