PURPOSE

To investigate the diagnostic value of elevated retinal pigment epithelium (RPE) and double-layer sign (DLS) in identifying macular neovascularization (MNV) secondary to central serous chorioretinopathy (CSCR).

DESIGN

Retrospective, cross-sectional study.

METHODS

Patients with CSCR underwent optical coherence tomography (OCT) and OCT angiography (OCT-A) scanning at Moorfields Eye Hospital. OCT scans were reviewed to identify the presence/absence of an RPE elevation. The maximum length and maximum height of the elevated RPE were measured. A minimum length of 1000 µm and a maximum height of 150 µm were used to define the “double-layer sign.” Other qualitative anatomical features were also graded from OCT scans. OCT-A was examined to confirm the presence/absence of MNV. Binary logistic regression analyses were used to assess the association between OCT features and the detection of MNV on OCT-A. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the diagnostic accuracy.

RESULTS

One hundred sixty-three eyes from 132 patients were included. Elevated RPE was detected in 148 eyes (91%). OCT-A–confirmed MNV was detected in 54 eyes (33%). The sensitivity and specificity of RPE elevation were 100% and 13.8%, respectively. DLS was identified in 95 eyes (58%). The sensitivity and specificity of DLS for detecting MNV were 87% and 56%, respectively. Hyperreflectivity and nonhomogeneity of the sub-RPE space were independently associated with MNV within the DLS (odds ratio, 17.7 and 14.8, P < .001 and P = .02, respectively). None of the other demographic or anatomical features were associated with MNV. The presence of nonhomogeneous hyperreflective RPE elevation had a sensitivity and specificity of 98% and 67%, with PPV and NPV of 60% and 99%, respectively.

CONCLUSIONS

Nonhomogeneous and hyperreflective space under an elevated RPE of any length or height indicates an eye with higher risk of MNV than DLS. OCT-A should at least be performed for these eyes to confirm the presence of MNV and treat accordingly.

中文翻译：

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中心性浆液性脉络膜视网膜病变继发黄斑新生血管的双层征象的诊断准确性

目的

探讨视网膜色素上皮（RPE）升高和双层征（DLS）在鉴别中心性浆液性脉络膜视网膜病变（CSCR）继发黄斑新生血管（MNV）中的诊断价值。

设计

回顾性横断面研究。

方法

CSCR 患者在 Moorfields 眼科医院接受了光学相干断层扫描 (OCT) 和 OCT 血管造影 (OCT-A) 扫描。审查 OCT 扫描以确定 RPE 升高的存在/不存在。测量了升高的 RPE 的最大长度和最大高度。最小长度为 1000 µm，最大高度为 150 µm 用于定义“双层标志”。其他定性解剖特征也从 OCT 扫描中分级。检查 OCT-A 以确认是否存在 MNV。二元逻辑回归分析用于评估 OCT 特征与 OCT-A 上 MNV 检测之间的关联。计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）以评估诊断准确性。

结果

包括来自 132 名患者的 163 只眼睛。在 148 只眼 (91%) 中检测到 RPE 升高。在 54 只眼 (33%) 中检测到 OCT-A 确认的 MNV。RPE升高的敏感性和特异性分别为100%和13.8%。在 95 只眼睛 (58%) 中发现了 DLS。DLS 检测 MNV 的敏感性和特异性分别为 87% 和 56%。亚 RPE 空间的超反射率和不均匀性与 DLS 内的 MNV 独立相关（优势比分别为 17.7 和 14.8，P < .001 和P  = .02）。其他人口统计学或解剖学特征均与 MNV 无关。存在非均匀性高反射性 RPE 升高的敏感性和特异性分别为 98% 和 67%，PPV 和 NPV 分别为 60% 和 99%。

结论

任何长度或高度的 RPE 升高下的非均匀和高反射空间表明眼睛患 MNV 的风险高于 DLS。至少应该对这些眼睛进行 OCT-A 以确认 MNV 的存在并进行相应的治疗。