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Review
. 2022 Feb 28;8(1):14.
doi: 10.1186/s40942-022-00365-5.

Optical coherence tomography in diagnosing polypoidal choroidal vasculopathy. Looking into the future: a systematic review and meta-analysis

Annisa C Permadi  1 , Ari Djatikusumo  2 , Gitalisa Andayani Adriono  2
Affiliations
Review

Optical coherence tomography in diagnosing polypoidal choroidal vasculopathy. Looking into the future: a systematic review and meta-analysis

Annisa C Permadi et al. Int J Retina Vitreous. .

Abstract

Background: Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy with features similar to wet age macular degeneration. The incidence of PCV is known to be higher in the Asian population compared to Caucasians. Imaging modality is needed to make the diagnosis of PCV. Although Indocyanine green angiography (ICGA) is still the gold standard, it is not routinely performed in vitreoretinal practice. Thus another imaging modality is currently a popular research area. Spectral domain optical coherence tomography (SD-OCT) has emerged as a new imaging modality mostly available in clinics. Some studies have reported the sensitivity and specificity of SD-OCT in diagnosing PCV with different results and thresholds.

Methods: Relevant studies from PubMed, Science Direct and Google Scholar databases were systematically searched. In random effect models using STATA 14 software, a meta-analysis was performed to determine the pooled diagnostic accuracy. QUADAS 2 was used to evaluate the risk of bias of each study by Revman 5.4 software.

Results: Seven eligible studies which met the inclusion and exclusion criteria were enrolled in this study. A total of 911 eyes were included to investigate the diagnostic accuracy of SD-OCT. As a result, the pooled sensitivity was 0.91 (95% CI 0.87-0.93), specificity 0.88 (95% 0.83-0.92), positive likelihood ratio 8, negative likelihood ratio 11, the area under the summary receiver operating characteristic curve 0.95 (95% CI 0.93-0.97), and diagnostic odds ratio 71.81 (95% CI 38.89-132.74).

Conclusion: SD-OCT provided a high diagnostic value for detecting PCV. Sharply peaked pigment epithelial detachment (PED), notched PED, bubble sign, multiple PED, and double-layer sign were the most common features found in PCV.

Keywords: Diagnosis; Indocyanine green angiography (ICGA); Meta-analysis; Optical coherence tomography (OCT); Polypoidal choroidal vasculopathy.

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Conflict of interest statement

We would like to give the following facts which may be considered as potential conflict to this work. We wish to confirm that there are no known conflict of interest in our publication, therefore we ensures that the publisher has the author’s license of copyright and permission to publish the studies.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study
Fig. 3
Fig. 3
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies
Fig. 4
Fig. 4
Forest plot for sensitivity and specificity showed excellent result for OCT alone in diagnosing PCV, despite the different threshold used in each study. Note that the heterogeneity was low, indicating a high certainty of evidence
Fig. 5
Fig. 5
Fagan’s nomogram displayed the value of positive LR at 8 and negative LR at 0.11 specified that OCT performed well at distinguishing PCV and non-PCV. Increase of pre-test to post-test probability way suggested to confirm the diagnosis
Fig. 6
Fig. 6
Bivariate SROC showed high AUC at 0.95 which is considered excellent. This area measured discrimination, that was, the ability of OCT to correctly classify those with and without the disease
Fig. 7
Fig. 7
The diagnostic odds ratio (DOR) is the ratio of positive likelihood ratio compared to negative likelihood ratio. It is the odds that the test produces positive results compared to the odds of negative results. DOR of 71.81 (38.89–132.74) revealed a good test performance of OCT
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