Detecting recurrent choroidal neovascularization. Comparison of clinical examination with and without fluorescein angiography
S. O. Sykes, N. M. Bressler, M. G. Maguire, A. P. Schachat and S. B. Bressler
Retinal Vascular Center, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Md.
OBJECTIVE/DESIGN: To evaluate prospectively the ability of three retina
specialists to detect recurrent choroidal neovascularization (CNV) after
clinical examination alone and then with fluorescein angiography at 3 and 6
weeks and at 3, 6, 9, and 12 months after laser photocoagulation. SETTING:
Single tertiary retinal referral center. PATIENTS: All patients who had
laser treatment for CNV within 14 months of their study visit. One hundred
thirty-seven eyes of 134 patients were evaluated during 401 visits. MAIN
OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, and
negative predictive value of clinical examination with biomicroscopy to
detect recurrent CNV when defined as leakage on the periphery of the
laser-treated area on the fluorescein angiogram. RESULTS: Ninety-seven
definite or probable recurrences in 56 eyes were identified on the
fluorescein angiogram. Clinical examination had a sensitivity of 59%,
specificity of 94%, positive predictive value of 76%, and negative
predictive value of 88%. These figures varied somewhat by underlying cause,
age, time since treatment, and lesion location. Using either a reported or
measured loss of vision with the results of biomicroscopy as an indication
of recurrence increased the sensitivity to 77% but reduced the specificity
to 81%. CONCLUSIONS: Clinical examination probably cannot replace
fluorescein angiography in detecting all recurrent CNV after laser
treatment. However, for follow-up visits in which recurrent CNV was not
suspected on biomicroscopy, definite or questionable recurrent CNV was
identified on the fluorescein angiogram only 12% of the time, while the
absence of recurrent CNV using this method was confirmed 88% of the time.
