短波自发荧光对黄斑囊样水肿的诊断价值

摘要

背景 黄斑囊样水肿(CME)可继发于多种眼底疾病,导致视力障碍,早期诊断和治疗尤为重要.临床上多种方法可以诊断CME,其中无创的检查方法有光学相干断层扫描(OCT)和短波自发荧光(SW-AF),已经证实OCT的诊断效率高,但SW-AF的诊断价值尚未确定. 目的 研究SW-AF对于CME的诊断价值.方法 纳入2010年5月至2011年8月在宁波市医疗中心李惠利医院眼科就诊的易引起CME的其他原发眼病或内眼手术史者140例189眼,所有患眼分别行SW-AF、红外光自发荧光(IR-AF)、荧光素眼底血管造影(FFA)、OCT检查,分析SW-AF对于诊断CME的灵敏度和特异度,将SW-AF、IR-AF和FFA的检查结果分别与OCT进行比较,判断SW-AF诊断CME的临床价值.所有纳入对象均签署相关检查知情同意书.结果 SW-AF诊断CME的灵敏度为78.29％,特异度为96.67％,约登指数为0.75,阳性预测值为98.06％,阴性预测值为67.44％,阳性似然比为3.61,阴性似然比为0.03,符合率为84.13％,曲线下面积(AUC)为0.875,95％可信区间(CI):0.823 ～0.926(P＜0.001).SW-AF和IR-AF对CME诊断阳性结果明显低于OCT,差异均有统计学意义(x2=22.53,91.35,均P＜0.001),SW-AF、IR-AF、FFA与OCT诊断间的一致性系数分别为0.67、0.12和0.85. 结论 SW-AF对诊断CME有较高的灵敏度和特异度,又能反映OCT所无法提供的RPE代谢信息.与OCT比较,SW-AF诊断CME的一致性高于IR-AF,但低于FFA.%Background Cystoid macular edema (CME) is a manifestation secondary to multiple fundus diseases and often leads to the decline of visual acuity.Optical coherence tomography (OCT) is a common diagnostic method for CME,but it can not reflect the metabolism information of retinal pigment epithelium (RPE).Shortwave autofluorescence (SW-AF)may find the abnormality of macula,but its clinical value remains to be confirmed.Objective This study was to investigate the value of SW-AF in the diagnosis of CME.Methods One hundred and eighty-nine eyes of 140 patients who have the relative diseases to CME or received intraocular surgery were included from May 2010 to August 2011 in Lihuili Hospital of Ningbo city.SW-AF,infrared autofluorescence (IRAF),fundus fluorescein angiography (FFA) and OCT were performed in all the eyes under the informed consent of each patient.The sensitivity,specificity and other indicators in diagnostic test of SW-AF for CME were evaluated and compared with OCT.Results SW-AF had certain accuracy in diagnosis of CME with the sensitivity 78.29％,specificity 96.67％,Youden index 0.75,positive predictive value 98.06％,negative predictive value 67.44％.The area under curve (AUC) of SW-AF for the diagnosis of CME was 0.875 with the 95％ confidence interval (CI) 0.823-0.926 (P＜0.001).Compared with OCT,the differences of SW-AF and IR-AF in the diagnosis for CME was statistically significant(x2 =22.53,91.35,both at P＜0.001),and agreement coefficients of diagnosis result between SW-AF、IR-AF or FFA and OCT were 0.67,0.12 and 0.85.Conclusions SW-AF can be used as a new rapid,non-invasive,ancillary technique in diagnosis of CME with certain accuracy,and the diagnostic agreement of SW-AF with OCT is lower than FFA but is higher than IR-AF.