Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy
Articolo
Data di Pubblicazione:
2015
Citazione:
Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy / G. Virgili, F. Menchini, G. Casazza, R. Hogg, R.R. Das, X. Wang, M. Michelessi. - In: COCHRANE DATABASE OF SYSTEMATIC REVIEWS. - ISSN 1469-493X. - 2015:1(2015), pp. CD008081.1-CD008081.58. [10.1002/14651858.CD008081.pub3]
Abstract:
Background Diabetic macular oedema (DMO) is a thickening of the central retina, or the macula, and is associated with long-term visual loss in people with diabetic retinopathy (DR). Clinically significant macular oedema (CSMO) is the most severe form of DMO. Almost 30 years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) found that CSMO, diagnosed by means of stereoscopic fundus photography, leads to moderate visual loss in one of four people within three years. It also showed that grid or focal laser photocoagulation to the macula halves this risk. Recently, intravitreal injection of antiangiogenic drugs has also been used to try to improve vision in people with macular oedema due to DR. Optical coherence tomography (OCT) is based on optical reflectivity and is able to image retinal thickness and structure producing cross-sectional and three-dimensional images of the central retina. It is widely used because it provides objective and quantitative assessment ofmacular oedema, unlike the subjectivity of fundus biomicroscopic assessment which is routinely used by ophthalmologists instead of photography. Optical coherence tomography is also used for quantitative follow-up of the effects of treatment of CSMO. Objectives To determine the diagnostic accuracy of OCT for detecting DMO and CSMO, defined according to ETDRS in 1985, in patients referred to ophthalmologists afterDR is detected. In the update of this review we also aimed to assess whetherOCTmight be considered the new reference standard for detecting DMO. Search methods We searched the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA) and the NHS Economic Evaluation Database (NHSEED) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1950 to June 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1990 to June 2013), BIOSIS Previews (January 1969 to June 2013), MEDION and the Aggressive Research Intelligence Facility database (ARIF).We did not use any date or language restrictions in the electronic searches for trials.We last searched the electronic databases on 25 June 2013.We checked bibliographies of relevant studies for additional references. Selection criteria We selected studies that assessed the diagnostic accuracy of anyOCTmodel for detectingDMOorCSMOin patientswithDR whowere referred to eye clinics. Diabetic macular oedema and CSMO were diagnosed by means of fundus biomicroscopy by ophthalmologists or stereophotography by ophthalmologists or other trained personnel. Data collection and analysis Three authors independently extracted data on study characteristics and measures of accuracy. We assessed data using random-effects hierarchical sROC meta-analysis models. Main results We included 10 studies (830 participants, 1387 eyes), published between 1998 and 2012. Prevalence of CSMO was 19% to 65% (median 50%) in nine studies with CSMO as the target condition. Study quality was often unclear or at high risk of bias for QUADAS 2 items, specifically regarding study population selection and the exclusion of participants with poor quality images. Applicablity was unclear in all studies since professionals referring patients and results of prior testing were not reported. There was a specific 'unit of analysis' issue because both eyes of the majority of participants were included in the analyses as if they were independent. In nine studies providing data on CSMO (759 participants, 1303 eyes), pooled sensitivity was 0.78 (95%confidence interval (CI) 0.72 to 0.83) and specificity was 0.86 (95%
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Diabetic Retinopathy; Diagnostic Errors; Humans; Macular Edema; Randomized Controlled Trials as Topic; Retina; Selection Bias; Sensitivity and Specificity; Tomography, Optical Coherence; Medicine (all); Pharmacology (medical)
Elenco autori:
V. Gianni, M. Francesca, G. Casazza, H. Ruth, D. Radha R., W. Xue, M. Manuele
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