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Titolo:
ASSESSMENT OF CYTOMEGALOVIRUS RETINITIS - CLINICAL-EVALUATION VS CENTRALIZED GRADING OF FUNDUS PHOTOGRAPHS
Autore:
LEWIS RA; CLOGSTON P; FAINSTEIN V; GROSS R; SAMO TC; TUTTLE C; JABS DA; APUZZO L; BARTLETT J; COLESON L; DUNN JP; ELDRED L; FEINBERG J; FLYNN T; KING R; LESLIE J; BARRON B; GREENSPAN D; HEINEMANN MD; POLSKY B; SQUIRES K; WISECAMPBELL S; FRIEDMAN AH; CHEUNG TW; JUSTIN N; TEICH S; SACKS H; SEVERIN C; FRIEDBERG DN; ADDESSI A; DIETERICH D; FROST K; WEINBERG D; JAMPOL L; MURPHY R; NAUGHTON K; HENDERLY D; HOLLAND GN; CHAFEY S; FALL H; HARDY WD; KIMBRELL C; MCARTHURCHANG L; FREEMAN WR; MEINERT L; PETERSON TJ; QUICENO JI; RICKMAN L; SIMANELLO MA; SPECTOR S; ODONNELL J; HOFFMAN J; IRVINE A; JACOBSON M; LARSON J; SEIFF S; WANNER M; DAVIS J; CHUANG E; ESPINAL M; MENDEZ P; VANDENBROUCKE R; CHEESMAN SH; GITTINGER J; HAUBRICH R; KACHADOORIAN H; TOLSON K; KLINE JM; KLEMM AC; STEVENS M; WEBB R; BROWNBELLAMY J; MARKOWITZ JA; BROOKMEYER R; COLLINS KB; COLLISON BJ; DODGE J; DONITHAN M; FINK N; GILPIN AMK; GERCZAK C; HOLBROOK JT; ISAACSON MR; LEVINE CR; MARTIN B; MIN YI; OWENS RM; NOWAKOWSKI DJ; SAAH A; SINGER S; SMITH M; STERNBERG AL; TONASCIA J; VANNATTA ML; DAVIES MD; AGRESSEGAL M; ARMSTRONG J; BRICKBAUER J; BROTHERS R; FREITAG G; HUBBARD L; HURLBURT D; JENSEN K; KASTORFF L; KING B; MAGLI Y; MESSING S; MINER K; NEIDER M; ONOFREY J; STOPPENBACH V; THOMAS S; VANDERHOOFYOUNG M; STEWART G; HUGHES R; WELCH L; KURINIJ N; MOWERY R; ELLENBERG S; KORVICK J; DAVIS MD; CLARK T; CLOGSTON PS; FREEMAN W; KOLVICK J; MOWERY R; SATTLER F; BROWN BW; CONWAY B; GRIZZLE J; NUSSENBLATT R; PHAIR J; SMITH H; WHITLEY R; BOWERS M; CHENG B; LAMBERT AG; LINK D;
Indirizzi:
JOHNS HOPKINS UNIV,SCH MED,WILMER OPHTHALMOL INST,550 N BROADWAY,SUITE 700 BALTIMORE MD 21205 BAYLOR COLL MED,CULLEN EYE INST HOUSTON TX 77030 LOUISIANA STATE UNIV,MED CTR NEW ORLEANS LA 00000 MEM SLOAN KETTERING CANC CTR NEW YORK NY 10021 NEW YORK HOSP,CORNELL MED CTR NEW YORK NY 10021 MT SINAI SCH MED NEW YORK NY 00000 NYU,MED CTR NEW YORK NY 00000 NORTHWESTERN UNIV CHICAGO IL 60611 UNIV CALIF LOS ANGELES LOS ANGELES CA 00000 UNIV CALIF SAN DIEGO SAN DIEGO CA 92103 USN HOSP BETHESDA MD 20814 UNIV CALIF SAN FRANCISCO SAN FRANCISCO CA 94143 UNIV MIAMI,SCH MED CORAL GABLES FL 33124 UNIV MASSACHUSETTS,MED CTR WORCESTER MA 00000 JOHNS HOPKINS UNIV,SCH HYG & PUBL HLTH BALTIMORE MD 21218 UNIV WISCONSIN,FUNDUS PHOTOGRAPH READING CTR MADISON WI 00000 ERC BIOSERV CORP,DRUG DISTRIBUT CTR ROCKVILLE MD 00000 NIAID BETHESDA MD 20892
Titolo Testata:
Archives of ophthalmology
fascicolo: 7, volume: 114, anno: 1996,
pagine: 791 - 805
SICI:
0003-9950(1996)114:7<791:AOCR-C>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
8
Recensione:
Indirizzi per estratti:
Citazione:
R.A. Lewis et al., "ASSESSMENT OF CYTOMEGALOVIRUS RETINITIS - CLINICAL-EVALUATION VS CENTRALIZED GRADING OF FUNDUS PHOTOGRAPHS", Archives of ophthalmology, 114(7), 1996, pp. 791-805

Abstract

Background: In the Foscarnet-Ganciclovir Cytomegalovirus (CMV) Retinitis Trial, time to first progression of newly diagnosed CMV retinitis was similar in the 2 treatment groups but was shorter when assessed bygrading of fundus photographs at a central reading center than when assessed at the participating clinical centers. This report describes the extent and causes of this disagreement and considers the implications of the findings for clinical practice and future research. Methods:Clinical findings and photographic gradings were compared for extent and activity of retinitis at baseline and during follow-up. In selected cases of disagreement, the photographs and summaries of gradings andclinical findings were reviewed concurrently to determine the cause of disagreement. Results: Movement of the border of retinitis was observed sooner and activity of the border was considered to have increasedmore often at the reading center than at the clinical centers. Disagreements on time to first progression were more frequent when degree ofborder movement was small (odds ratios [ORs] for several comparisons ranged from 1.7 to 5.2), when border activity was judged to have decreased or remained the same since the preceding visit (OR, 2.0-193), andwhen retinitis at baseline did not involve zone 1 (the area within 1 disc diameter of the disc or within 2 disc diameters of the center of the macula [OR, 1.4-3.6]). There were 2 important causes of disagreement between clinical center and reading center. First, difficulty was encountered clinically in recognizing retinitis border movement in the absence of an obvious increase in border activity. Second, the readingcenter used a threshold for border movement small enough to be crossed by an initial expansion of retinitis borders occurring within 2 to 5weeks of enrollment in some patients who were responding favorably totreatment (in that retinitis was becoming inactive and showed no further progression for many weeks). Conclusions: Comparisons of photographs from the current visit with those from several previous visits may increase clinicians' abilities to detect progression promptly. The useof additional outcome measures by reading centers, such as border movement of 1500 pm or more and change in area of retina involved by retinitis, may provide more accurate and useful comparisons of treatments. In making such comparisons, centralized photographic grading has the advantages of greater reproducibility and lesser risk of observer bias.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/04/20 alle ore 01:27:31