Abstract：
OBJECTIVE: To evaluate the agreement and predictability of ocriplasmin treatment effects among retinal experts (raters) by assessment of retinal imaging data of eyes treated for vitreomacular traction in nine different centers in Germany and Austria.
METHODS: Retrospective cohort study. Combined confocal near-infrared scanning laser ophthalmoscopy and spectral-domain optical coherence tomography images (Spectralis® device, Heidelberg Engineering GmbH, Germany) from 136 eyes of 135 subjects were reviewed by 14 raters using an internet-based grading database and a standardized questionnaire. In addition to the images taken within 2 days prior to treatment, age, gender, and lens status were disclosed to the raters. Treatment success was defined as a complete cleavage of the posterior vitreous cortex at day 28±5. Main outcome was the agreement and predictability among raters for assessment of treatment success.
RESULTS: Raters generally accepted starting ocriplasmin treatment (chance for treatment success ≥ 1%) in 22.4 to 69.1% (median 53.2%) of eyes (moderate intra- and interrater agreements with kappa-values of 0.6 and 0.48). The likelihood for a high potential treatment success (equal or higher than 25%) was judged by the raters in 43.4% to 86.0% (median 62.6%) of eyes (moderate intra- and fair interrater agreements with kappa-values of 0.56 and 0.22). Allocating eyes for high potential treatment success overall increased the odds by 3.07, with odds ratios of single raters up to 4.06 to 6.16.
CONCLUSIONS: These results underscore the importance of training health care providers in the evaluation of retinal imaging data and also to define characteristic morphological features better in the presence of vitreoretinal interface diseases. The better results of single raters in the predictability of treatment success by the allocation of eyes in the high-potential group indicates the high relevance of the meticulous analysis of retinal images.
METHODS: Retrospective cohort study. Combined confocal near-infrared scanning laser ophthalmoscopy and spectral-domain optical coherence tomography images (Spectralis® device, Heidelberg Engineering GmbH, Germany) from 136 eyes of 135 subjects were reviewed by 14 raters using an internet-based grading database and a standardized questionnaire. In addition to the images taken within 2 days prior to treatment, age, gender, and lens status were disclosed to the raters. Treatment success was defined as a complete cleavage of the posterior vitreous cortex at day 28±5. Main outcome was the agreement and predictability among raters for assessment of treatment success.
RESULTS: Raters generally accepted starting ocriplasmin treatment (chance for treatment success ≥ 1%) in 22.4 to 69.1% (median 53.2%) of eyes (moderate intra- and interrater agreements with kappa-values of 0.6 and 0.48). The likelihood for a high potential treatment success (equal or higher than 25%) was judged by the raters in 43.4% to 86.0% (median 62.6%) of eyes (moderate intra- and fair interrater agreements with kappa-values of 0.56 and 0.22). Allocating eyes for high potential treatment success overall increased the odds by 3.07, with odds ratios of single raters up to 4.06 to 6.16.
CONCLUSIONS: These results underscore the importance of training health care providers in the evaluation of retinal imaging data and also to define characteristic morphological features better in the presence of vitreoretinal interface diseases. The better results of single raters in the predictability of treatment success by the allocation of eyes in the high-potential group indicates the high relevance of the meticulous analysis of retinal images.
摘要：
目的：通过评估德国和奥地利9个不同中心接受玻璃体黄斑牵引治疗的眼睛的视网膜成像数据，评估视网膜专家（评估者）对ocriplasmin治疗效果的一致性和可预测性。
方法：回顾性队列研究。组合的共焦近红外扫描激光检眼镜和光谱域光学相干断层扫描图像（Spectralis®设备，海德堡工程有限公司,德国）来自135名受试者的136只眼睛，由14名评估者使用基于互联网的分级数据库和标准化问卷进行了审查。除了治疗前2天内拍摄的图像外，年龄,性别,和镜头状态被披露给评估者。治疗成功定义为在第28±5天玻璃体后皮质的完全卵裂。主要结果是评估者之间对治疗成功评估的一致性和可预测性。
结果：评估者通常接受22.4％至69.1％（中位数为53.2％）的眼睛开始使用奥氏酶治疗（治疗成功率≥1％）（中度评估者内和评估者之间的协议，卡伯值为0.6和0.48）。评估者在43.4％至86.0％（中位数为62.6％）的眼睛中判断了高潜在治疗成功（等于或高于25％）的可能性（中度和公平的评估者间协议，卡伯值为0.56和0.22）。为高潜在治疗成功率分配眼睛总体上增加了3.07的赔率，单个评分者的赔率比高达4.06至6.16。
结论：这些结果强调了在评估视网膜成像数据方面培训医疗保健提供者的重要性，以及在存在玻璃体视网膜界面疾病的情况下更好地定义特征性形态学特征。通过在高电位组中分配眼睛，单个评估者在治疗成功的可预测性方面的更好结果表明，对视网膜图像的细致分析具有很高的相关性。
方法：回顾性队列研究。组合的共焦近红外扫描激光检眼镜和光谱域光学相干断层扫描图像（Spectralis®设备，海德堡工程有限公司,德国）来自135名受试者的136只眼睛，由14名评估者使用基于互联网的分级数据库和标准化问卷进行了审查。除了治疗前2天内拍摄的图像外，年龄,性别,和镜头状态被披露给评估者。治疗成功定义为在第28±5天玻璃体后皮质的完全卵裂。主要结果是评估者之间对治疗成功评估的一致性和可预测性。
结果：评估者通常接受22.4％至69.1％（中位数为53.2％）的眼睛开始使用奥氏酶治疗（治疗成功率≥1％）（中度评估者内和评估者之间的协议，卡伯值为0.6和0.48）。评估者在43.4％至86.0％（中位数为62.6％）的眼睛中判断了高潜在治疗成功（等于或高于25％）的可能性（中度和公平的评估者间协议，卡伯值为0.56和0.22）。为高潜在治疗成功率分配眼睛总体上增加了3.07的赔率，单个评分者的赔率比高达4.06至6.16。
结论：这些结果强调了在评估视网膜成像数据方面培训医疗保健提供者的重要性，以及在存在玻璃体视网膜界面疾病的情况下更好地定义特征性形态学特征。通过在高电位组中分配眼睛，单个评估者在治疗成功的可预测性方面的更好结果表明，对视网膜图像的细致分析具有很高的相关性。
