Diagnosis value of shortwave autofluorescence for cystoid macular edema

Abstract

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 (IR-AF), 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(χ2=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. Key words: Macular edema/diagnosis; Fundus autofluorescence; Tomography, optical coherence; Fundus fluorescein angiography; Lipofuscin/metabolism; Diagnostic test