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Article Type

Original Study

Abstract

Objectives The aim of this work was to study the role of fundus fluorescein angiography and spectral domain optical coherence tomography (SDOCT) in the diagnosis of wet age-related macular degeneration (AMD). Background AMD is the leading cause of severe visual impairment in elderly people. Various imaging methods are available for the diagnosis and the classification of AMD. Fluorescein angiography (FA) is the gold standard for the differential diagnosis of neovascular AMD and determination of lesion characteristics. SDOCT is used for the diagnosis and the follow-up of patients with neovascular AMD undergoing antivascular endothelial growth factor therapy, by providing high-resolution cross-sectional images of retinal pathology. Participants and methods This study included 30 patients divided into three groups: group Me, patients with dry AMD; group II, patients with wet AMD divided into classic choroidal neovascularization (CNV) and occult CNV; group III, patients with geographic atrophy. All participants underwent a full ophthalmologic evaluation, including dilated fundus examination by binocular indirect ophthalmoscope. Slit-lamp biomicroscopy was performed using the Goldman three mirror lens and Volk 78 lens; also, the best-corrected visual acuity was measured with the Landolt chart and converted to the logarithm of the minimum angle of resolution (logMAR) units, and fundus fluorescein angiography and then optical coherence tomography (OCT) were performed. Results Using SDOCT imaging to delineate the lesion morphology, early AMD was detected by the presence of a normal foveal contour and minimal alteration in the macular area, classic CNV by the presence of a well-defined lesion with steep margins and a crater like configuration, and occult CNV by the presence of an ill-defined, flat lesion with a convex surface. FA-OCT overlay images provided a significant correlation between FA patterns and OCT features such as retinal pigment epithelium (RPE) complex changes. The sensitivity of cases with dry AMD in FA to cases with undulation in OCT was 100%, the specificity was 92%, the accuracy was 93%, the positive predictive value (PPV) was 75%, and the negative predictive value (NPV) was 100%. The sensitivity of cases with wet AMD in FA to cases with thickening in OCT was 96%, the specificity was 20%, the accuracy was 83%, the PPV was 86%, and the NPV was 50%. The sensitivity of cases with geographic atrophy of AMD in FA to cases with thinning in OCT was 100%, the specificity was 97%, the accuracy was 97%, the PPV was 50%, and the NPV was 100%. Conclusion SDOCT is highly sensitive for identifying AMD, CNV, and CNV activity, but cannot fully replace FA in the diagnosis of AMD.

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