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- W2941702100 abstract "In the study by Pavan Kumar et al.,1 the authors addressed an important issue for clinical practice and reported that anterior segment optical coherence tomography (AS-OCT) has high sensitivity (100%) and specificity (94.9%) for predicting posterior capsule rupture during phacoemulsification surgery in eyes with posterior polar cataract. Here, we present our concerns about this study and our recommendations. The authors stated that a single rater performed the AS-OCT image analysis. The number of assessments was not provided, and it is not clear whether the rater was masked to the clinical information. Furthermore, if the rater performed analysis more than once for each image, intrarater reliability should have been tested and the results provided.2 The rater classified 3 eyes as dehiscent based on preoperative AS-OCT images, in which the posterior capsule was found to be intact intraoperatively. We reviewed the AS-OCT images of these misclassified eyes (Figure 3 in original article), and we performed a simple further analysis using medical image-processing software (ImageJ, version 1.52aA). First, AS-OCT images (Figure 1 and Figure 3 in original article) were downloaded from the journal’s website and transferred to the ImageJ software as .jpeg files. Light enhancement was performed (using Image→Adjust→Brightness/Contrast menu) for both figures until maximum posterior capsule visibility was provided in weak signals (if any). The light-enhanced versions of Figures 1 and 3 were merged to create a new figure, which we present here (Figure 1). The posterior capsule image pattern in Figure 1, A, which is an enhanced version of Figure 1, A, provided by the authors to show an intact posterior capsule, was used as reference for determining capsule integrity. With the enhanced images, we were able to track posterior capsule continuity in 2 eyes, shown in Figure 1, D and E, and these eyes should be classified as intact. However, in Figure 1, C, the posterior capsule was still disrupted. The authors stated that the image of posterior capsule dehiscence was probably the result of shadowing effect of the localized dense lens opacity; this eye should be designated as dehiscent based on the enhanced image.Figure 1: Light-enhanced merged version of authors’ Figure 1 and Figure 3 from the original study. A and B: Sample cases of posterior polar cataract with intact posterior capsule (green arrows) and dehiscent posterior capsule (red arrows). D and E: After light enhancement, the posterior capsule was found to be intact in 2 eyes (white arrows), which were misclassified as dehiscent in the original study. C: However, in 1 eye, the posterior capsule seemed to be dehiscent (white notched arrow), as the authors stated.After image enhancement, 2 of the 3 eyes that were misclassified as dehiscent in the original study could be correctly classified as intact and the final specificity of the preoperative AS-OCT increased to 98.3% from 94.9% (also to 83.3% of positive predictive value from 62.5%) for predicting posterior capsule rupture in phacoemulsification for posterior polar cataract. However, the sensitivity and negative predictive value remained unchanged (both 100%) because all intraoperatively dehiscent posterior capsules were correctly detected by preoperative AS-OCT imaging in the study. We think that multiple assessments of a subjective test at different times by 1 or more raters with intrarater and/or interrater agreement calculation are mandatory for presenting the ability of a diagnostic test. On the other hand, simple image adjustments could significantly improve the sensitivity and specificity of preoperative AS-OCT images for predicting posterior capsule rupture during phacoemulsification in cases with posterior polar cataract." @default.
- W2941702100 created "2019-05-03" @default.
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- W2941702100 date "2019-05-01" @default.
- W2941702100 modified "2023-09-25" @default.
- W2941702100 title "Using preoperative anterior segment optical coherence tomography to highly predict posterior capsule dehiscence in posterior polar cataract with simple image adjustments" @default.
- W2941702100 cites W2892203474 @default.
- W2941702100 doi "https://doi.org/10.1016/j.jcrs.2019.01.038" @default.
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%20has%20high%20sensitivity%20(100%25)%20and%20specificity%20(94.9%25)%20for%20predicting%20posterior%20capsule%20rupture%20during%20phacoemulsification%20surgery%20in%20eyes%20with%20posterior%20polar%20cataract.%20Here%2C%20we%20present%20our%20concerns%20about%20this%20study%20and%20our%20recommendations.%20The%20authors%20stated%20that%20a%20single%20rater%20performed%20the%20AS-OCT%20image%20analysis.%20The%20number%20of%20assessments%20was%20not%20provided%2C%20and%20it%20is%20not%20clear%20whether%20the%20rater%20was%20masked%20to%20the%20clinical%20information.%20Furthermore%2C%20if%20the%20rater%20performed%20analysis%20more%20than%20once%20for%20each%20image%2C%20intrarater%20reliability%20should%20have%20been%20tested%20and%20the%20results%20provided.2%20The%20rater%20classified%203%20eyes%20as%20dehiscent%20based%20on%20preoperative%20AS-OCT%20images%2C%20in%20which%20the%20posterior%20capsule%20was%20found%20to%20be%20intact%20intraoperatively.%20We%20reviewed%20the%20AS-OCT%20images%20of%20these%20misclassified%20eyes%20(Figure%203%20in%20original%20article)%2C%20and%20we%20performed%20a%20simple%20further%20analysis%20using%20medical%20image-processing%20software%20(ImageJ%2C%20version%201.52aA).%20First%2C%20AS-OCT%20images%20(Figure%201%20and%20Figure%203%20in%20original%20article)%20were%20downloaded%20from%20the%20journal%E2%80%99s%20website%20and%20transferred%20to%20the%20ImageJ%20software%20as%20.jpeg%20files.%20Light%20enhancement%20was%20performed%20(using%20Image%E2%86%92Adjust%E2%86%92Brightness%2FContrast%20menu)%20for%20both%20figures%20until%20maximum%20posterior%20capsule%20visibility%20was%20provided%20in%20weak%20signals%20(if%20any).%20The%20light-enhanced%20versions%20of%20Figures%201%20and%203%20were%20merged%20to%20create%20a%20new%20figure%2C%20which%20we%20present%20here%20(Figure%201).%20The%20posterior%20capsule%20image%20pattern%20in%20Figure%201%2C%20A%2C%20which%20is%20an%20enhanced%20version%20of%20Figure%201%2C%20A%2C%20provided%20by%20the%20authors%20to%20show%20an%20intact%20posterior%20capsule%2C%20was%20used%20as%20reference%20for%20determining%20capsule%20integrity.%20With%20the%20enhanced%20images%2C%20we%20were%20able%20to%20track%20posterior%20capsule%20continuity%20in%202%20eyes%2C%20shown%20in%20Figure%201%2C%20D%20and%20E%2C%20and%20these%20eyes%20should%20be%20classified%20as%20intact.%20However%2C%20in%20Figure%201%2C%20C%2C%20the%20posterior%20capsule%20was%20still%20disrupted.%20The%20authors%20stated%20that%20the%20image%20of%20posterior%20capsule%20dehiscence%20was%20probably%20the%20result%20of%20shadowing%20effect%20of%20the%20localized%20dense%20lens%20opacity%3B%20this%20eye%20should%20be%20designated%20as%20dehiscent%20based%20on%20the%20enhanced%20image.Figure%201%3A%20Light-enhanced%20merged%20version%20of%20authors%E2%80%99%20Figure%201%20and%20Figure%203%20from%20the%20original%20study.%20A%20and%20B%3A%20Sample%20cases%20of%20posterior%20polar%20cataract%20with%20intact%20posterior%20capsule%20(green%20arrows)%20and%20dehiscent%20posterior%20capsule%20(red%20arrows).%20D%20and%20E%3A%20After%20light%20enhancement%2C%20the%20posterior%20capsule%20was%20found%20to%20be%20intact%20in%202%20eyes%20(white%20arrows)%2C%20which%20were%20misclassified%20as%20dehiscent%20in%20the%20original%20study.%20C%3A%20However%2C%20in%201%20eye%2C%20the%20posterior%20capsule%20seemed%20to%20be%20dehiscent%20(white%20notched%20arrow)%2C%20as%20the%20authors%20stated.After%20image%20enhancement%2C%202%20of%20the%203%20eyes%20that%20were%20misclassified%20as%20dehiscent%20in%20the%20original%20study%20could%20be%20correctly%20classified%20as%20intact%20and%20the%20final%20specificity%20of%20the%20preoperative%20AS-OCT%20increased%20to%2098.3%25%20from%2094.9%25%20(also%20to%2083.3%25%20of%20positive%20predictive%20value%20from%2062.5%25)%20for%20predicting%20posterior%20capsule%20rupture%20in%20phacoemulsification%20for%20posterior%20polar%20cataract.%20However%2C%20the%20sensitivity%20and%20negative%20predictive%20value%20remained%20unchanged%20(both%20100%25)%20because%20all%20intraoperatively%20dehiscent%20posterior%20capsules%20were%20correctly%20detected%20by%20preoperative%20AS-OCT%20imaging%20in%20the%20study.%20We%20think%20that%20multiple%20assessments%20of%20a%20subjective%20test%20at%20different%20times%20by%201%20or%20more%20raters%20with%20intrarater%20and%2For%20interrater%20agreement%20calculation%20are%20mandatory%20for%20presenting%20the%20ability%20of%20a%20diagnostic%20test.%20On%20the%20other%20hand%2C%20simple%20image%20adjustments%20could%20significantly%20improve%20the%20sensitivity%20and%20specificity%20of%20preoperative%20AS-OCT%20images%20for%20predicting%20posterior%20capsule%20rupture%20during%20phacoemulsification%20in%20cases%20with%20posterior%20polar%20cataract.%22){kind=link}