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1 대한안과학회지 2010 년제 51 권제 3 호 J Korean Ophthalmol Soc 2010;51(3): pissn: eissn: DOI : /jkos = 증례보고 = 당뇨황반부종에서시간과스펙트럼도메인빛간섭단층촬영으로측정한황반두께의반복성과일치도 오세범 문준웅 김형찬 건국대학교의학전문대학원안과학교실 목적 : 당뇨황반부종환자에서 time domain (TD) OCT 와 spectral domain (SD) OCT 로황반두께와총황반부피를측정해반복성과일치도를비교해보고자하였다. 대상과방법 : 당뇨황반부종 42 명, 42 안을대상으로 TD OCT 와 로 3 회연속황반두께와총황반부피를측정하여비교하였다. 개체내표준편차, 변동계수, 급내상관계수로반복성을, Bland Altman plot 으로일치도를평가하였다. 또한 Pearson 상관계수를통해두 OCT 사이의상관관계를알아보았다. 결과 : TD OCT 와 로측정한중심와두께, 총황반부피의개체내표준편차는각각 μm/16.44 μm, 1.26 mm 3 /0.23 mm 3 로 에서유의하게낮았다. 변동계수와급내상관계수는 TD OCT 에서각각 2.92%, 0.92 이었고, 에서각각 1.39%, 0.95 이었다. 중심와두께와총황반부피의 95% 일치도범위는각각 88.9 μm, 2.4 mm 3 이었다. 두 OCT 사이의모든황반두께와총황반부피는통계적으로유의한상관관계를보였다 (p= ). 결론 : 당뇨황반부종에서두 OCT 로측정한황반두께및황반부피는높은신뢰성을보이나 에서더높은반복성을보였다. 두 OCT 로측정한황반두께및황반부피는낮은일치도를보여상호교환적이지않았으나두 OCT 간유의한상관관계를보였다. < 대한안과학회지 2010;51(3): > 황반질환에서정확하고신뢰성있는황반두께측정은진단, 시력예후, 치료시기판정, 치료효과평가에매우중요하다. 황반두께를측정하는방법으로세극등현미경을이용한안저검사, 형광안저혈관조영술, 빛간섭단층촬영 (optical coherence tomography, OCT) 등이있으며, 그중에서 OCT 는민감도가매우높고해상력이높아망막의여러층을정확히알수있고정량적인측정이가능하여황반질환진단에가장널리쓰이고있다. 1-5 반복성이란한사람이같은측정장비를이용하여동일한대상을여러번측정했을때얼마나같은결과를보일수있는지를알수있는지표로서, 임상에있어어떤측정장비의반복성은그결과에대한해석에많은영향을미칠수있다. 지금까지널리쓰이고있는 time domain (TD) OCT의정상안에대한반복성연구에서 Gurses-Ozden et al은황반두께의변동계수가 4.7~6.4% 이었고, 6 Paunescu 접수일 : 2009 년 5 월 15 일 심사통과일 : 2009 년 12 월 2 일 책임저자 : 김형찬서울특별시광진구화양동 4-12 번지건국대학교병원안과 Tel: , Fax: eyekim@kuh.ac.kr * 본논문의요지는 2009 년대한안과학회제 101 회춘계학술대회에서구연으로발표되었음. et al은전체및구역별황반두께의급내상관계수가 0.55~ 0.97로각각높은반복성을보인다고하였다. 7 정상안뿐아니라당뇨황반부종안에대한반복성연구에서도황반두께측정치는 0.80 이상의급내상관계수를보인다는보고가있다. 8 최근개발된 spectral domain (SD) OCT는 TD OCT 에비해 50~100배로스캔속도가빨라졌고, 높은해상도를보여망막내구조를더자세하게보여줄수있다. 9,10 저자들은정상안을대상으로한 TD OCT 와 의반복성및일치도연구에서 에서 TD OCT 에비해유의하게더높은반복성을보였고, 두 OCT는낮은일치도를보여두 OCT간상호교환적이지않았다는결과를보고하였고, 이러한결과는이전의다른연구결과와같았다. 11,12 본연구의목적은당뇨황반부종에서 TD OCT 와 SD OCT로측정한황반두께와총황반부피를비교하여이들의반복성 (repeatability) 과일치도 (agreement) 를알아보고자하는데있다. 대상과방법 2009년 1월부터 2009년 4월까지본원안과에서안저검사상유의한당뇨황반부종으로진단받고, TD OCT상중심 372

2 - 오세범외 : 의통계적반복성과일치도 - 황반두께가 250 μm 이상이고, 이미지질값 (image quality score) 이 TD OCT 에서는 6 이상, 에서는 16 db이상이고, 안구내다른질환이없는경우를대상으로하였다. 망막정맥폐쇄, 망막전막, 유리체황반견인등의황반두께를증가시킬수있는질환이있는경우, 각막혼탁과백내장등의유의한매체혼탁이있는경우, 그리고이전에안구내수술을받은경우는대상에서제외하였다. 황반두께는양안이대상안인경우무작위로한쪽눈을선택해산동상태에서단일검사자에의해 3회연속적으로 TD OCT 및 를이용하여측정하였다. 그리고두 OCT의측정시피검자에게검사기구에대한설명없이하는단순맹검법으로연구를진행하였다. TD OCT 는 Stratus OCT (Carl Zeiss Meditec, Dublin, CA, USA) 를사용하였다. 황반두께는중심와를지나는 6개의 6 mm 길이의선형스캔이 30 간격으로방사상주사를하는 fast macular map 을이용하였으며, 황반두께지도 (macular thickness map) 로분석하였다. 황반두께지도는중심와를중심으로직경 1 mm 이내의중심원과 3 mm의안쪽원, 그리고 6 mm의바깥쪽원으로구성되며, 안쪽원과바깥쪽원은상측, 비측, 하측, 이측의 4분역으로나누어모두 9개의구역이된다. 측정된값은 retinal thickness analysis system 을통해분석하였다. 는 Spectralis OCT (Heidelberg Engineering, Dossenheim, Germany) 를사용하였다. 황반두께측정은래스터주사 (raster scan) 방식으로황반을중심으로수평, 수직이각각 768 pixel 496 pixel scan 방식으로이루어졌다. Spectralis OCT는 Stratus OCT 에서와같이직경 1, 3, 6 mm의동심원을 9개분역으로나누어분석하였다. 통계적분석은 SPSS version 15.0 (SPSS Inc, Chicago, III) 을사용하였다. 두 OCT의측정치는반복성 (repeatability) 을평가하기위해개체내표준편차 [2.77 within subject standard deviation (Sw)], 변동계수 (coefficient of variation, CVw) [100 Sw / overall mean], 급내상관계수 (intraclass correlation coefficient, ICC) 를계산하여비교하였다. 일치도를평가하기위해 Bland and Altman plots 을이용하였다. 13 그리고 Pearson 상관계수를통해두 OCT 사이의상관관계에대해서도알아보았다. 자료값과평균차이값의제곱의합을도수의합으로나눈것이분산이며, 이것의제곱근이표준편차이다. 표준편차는절대치크기로표현되기때문에데이터의단위가서로다른값들의산포도를비교할수없으며또한평균이다르면산포도의정도를비교하기곤란한경우가있다. 이러한경우단위에영향을받지않는변동계수, 즉, 표준편차를평균으로나눈값을사용함으로써산포도, 즉데이터의퍼 Table 1. Baseline characteristics Number of Eyes 42 Mean age ± SD * (years) 58.6 ± 8.2 Type of DME Diffuse retinal thickness 16 CME 23 Serous RD 3 Signal Strength Stratus OCT 6.5 ± 0.5 Spectralis OCT (db) 24.0 ± 3.7 * SD=standard deviation; DME=diabetic macular edema; CME= cystoid macular edema; RD=retinal detachment; OCT= optic coherence tomography. 짐정도를알수있다. 변동계수는값이작을수록산포가크지않고특성의차이가없는균일한것을의미하게된다. 급내상관계수 (ICC) 는개체간분산 (inter-subject variance) 을개체간분산에개체내분산 (within subject variance) 을더한총분산 (total variance) 으로나눈값으로서, 반복적인측정의일치정도를설명하는값으로 1 에가까울수록높은반복성을나타낸다. 두 OCT에의해측정된황반두께와총황반부피의개체내분산은 log화된데이터로전환한후 paired t-test로비교하였다. 14 모든통계적인유의성은 p<0.05 미만으로하였다. 결 과 대상안은 42명, 42안으로평균연령은 58.6±8.2세였고, OCT상당뇨황반부종의종류는미만성망막부종 (diffuse retinal thickness) 이 16안, 낭포황반부종이 23안, 장액망막박리가 3안이었고, 후유리체견인과견인망막박리형태는보이지않았다. TD OCT의 signal strength에해당하는평균이미지질값 (image quality score) 은 6.5±0.5이었고, 는 24.0±3.7dB이었다 (Table 1). TD과 에의해측정된평균값은중심와두께 (foveal thickness) 에서각각 367.2±155.0 μm와 427.6± μm이었고, 총황반두께 (total macular thickness) 에서각각 312.1±96.6 μm와 367.3±100.0 μm, 총황반부피 (total macular volume) 에서각각 8.6±1.7 mm 3 와 10.0± 1.6 mm 3 이었으며, 로측정한전체및구역별황반두께와총황반부피는 TD OCT 로측정한것보다통계적으로유의하게높은값을보였다 (Table 2). TD OCT 와 로측정한중심와두께, 총황반두께, 총황반부피의개체내표준편차는각각 μm/16.44 μm, 8.56 μm/5.08 μm, 1.26 mm 3 /0.23 mm 3 로 에서높은반복성을보였다. 그리고변동계수는각각 2.92%/1.39%, 2.99%/1.50%, 2.10%/1.97% 이고, 급내상관계수는각각 373

3 - 대한안과학회지 2010 년제 51 권제 3 호 SD SD Mean Mean SD SD Average of Spectralis OCT and Stratus OCT Figure 1. Bland-Altman plots of foveal thickness measurements obtained by Stratus OCT and Spectralis OCT. Solid line indicates the average mean difference, while dotted lines delineates the 95% confidence limits of agreement. 0.92/0.95, 0.91/0.90, 0.80/0.93로 에서반복성이유의하게더높았다 (Table 3). TD OCT 상중심황반두께가 400 μm를기준으로반복성을비교했을때, 중심황반두께가 400 μm 미만일때중심황반두께의변동계수는 TD OCT 에서 2.48%, 에서 1.19% 로유의한차이를보였다. 그리고중심황반두께가 400 μm 이상에서는 TD OCT 에서3.07%, 에서 1.72% 로차이를보였으나유의한차이를보이지않았다. 그리고두기종내에서비교했을때, 변동계수가 TD OCT 는 2.48% 에서 3.07% 로 에서는 1.38% 에서 1.72% 로중심황반두께가 400 μm 이상인경우반복성이유의하 Average of Spectralis OCT and Stratus OCT Figure 2. Bland-Altman plots of total macular thickness obtained by Stratus OCT and Spectralis OCT. Solid line indicates the average mean difference, while dotted lines delineates the 95% confidence limits of agreement. 게낮았다 (Table 4). 중심와두께, 총황반두께에대한 95% 의일치도범위는각각 88.9 μm, 66.7 μm 이었다 (Fig. 1, 2). 두 OCT에대한 95% 의일치도범위는 d 1.96s 에서 d s[d; SD OCT 평균값 TD OCT 평균값, s; 표준편차 ] 이므로, 중심와두께에서두 OCT 평균값차이의 95% 일치도범위는 16.0 μm 에서 μm 까지이다 (Fig. 1, Table 2). 두 OCT로측정한황반두께측정값사이의상관관계를알아보기위한 Pearson 상관계수는총황반두께 (0.99) 에서가장높았고, 바깥쪽원의하측 (0.88) 에서가장낮았다. 그리고두 OCT 사이의모든황반두께와총황반부피의상관 Table 2. Comparison of regional and total macular thicknesses measured by spectral domain and time domain optical coherence tomography Stratus OCT Spectralis OCT Mean difference 95% limits of p-values (mean±sd) (mean±sd) (-TD OCT) agreement Foveal thickness 367.2± ±147.4 < ( ) Inner subfield thickness Temporal 352.3± ± 88.3 < ( ) Superior 358.2± ± 90.0 < ( ) Nas al 358.1± ±100.6 < ( ) Inferior 347.3± ± 86.7 < ( ) Outer subfield thickness Temporal 274.4± ± 67.0 < ( ) Superior 286.2± ± 63.7 < ( ) Nas al 307.5± ± 68.5 < ( ) Inferior 274.9± ± 54.5 < ( ) macular thickness 312.1± ±100.0 < ( ) macular volume 8.6± ± 1.6 < ( ) 374

4 - 오세범외 : 의통계적반복성과일치도 - Table 3. Within-subject standard deviation (Sw), coefficient of variation (CVw), and intraclass correlation coefficient (ICC) of total and regional macular thicknesses obtained with time domain OCT and spectral domain OCT Foveal Inner subfield thickness Outer subfiled thickness Temporal Superior Nasal Inferior Temporal Superior Nasal Inferior Volume Sw TD OCT CVw TD OCT ICC TD OCT p-value * < <0.001 < * Companson of within-subject variances between stratus OCT and Spectralis OCT (paired t test on log-transformed data). Table 4. Within-subject standard deviation (Sw), coefficient of variation (CVw), and intraclass correlation coefficient (ICC) of total and regional macular thicknesses obtained with time domain OCT and spectral domain OCT between below 400 μm and over 400 μm FT<400 μm (26 eyes) FT 400 μm (16 eyes) Fovea Volume Fovea Volume Sw CVw TD OCT TD OCT p= p=0.043 ICC TD OCT p-value* < * Companson of within-subject variances between stratus OCT and Spectralis OCT (paired t test on log-transformed data) Table 5. Pearson correlation coefficient of macular thicknesses and total macular volume obtained with time domain OCT and spectral domain OCT Pearson correlation coeffcient Foveal Inner subfield thickness Outer subfiled thickness Temporal Superior Nasal Inferior Temporal Superior Nasal Inferior Volume p-value * <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 * Pearson's correlation coefficient between stratus OCT and spectralis OCT. 계수는통계적으로유의하였다 (p<0.001, Table 5). 고찰 지금까지황반두께측정에널리쓰이고있는 TD OCT 는초당 400 A-scan의속도와 10 μm의축해상도를보이는반면, 최근개발된 는초당 20,000 이상으로 TD OCT에비해 50배이상의빠른 A-scan 속도와 5 μm의축해상도를보인다. 작동원리는두 OCT가비슷하지만, TD OCT는 reference mirror가움직이면서시간에따른신호를측정해속도가느리나, 는 reference mirror가 고정되어있으며간섭계 (interferometer) 에서나온 light spectrum을동시에분광계 (spectrometer) 로탐지한후망막의두께정보를측정한다. 또한 TD OCT 는황반중심을가로지르는방사상의 6개선형을따라표본추출을하기때문에전체황반의 5% 만측정이가능하며이를보완하기위해황반두께를외삽법 (extrapolation) 으로추정하게된다. 이에비해 는수평주사선을화면의위에서부터아래로내려가면서한줄씩주사하여화면을형성하는래스터주사 (raster scan) 방식으로더많은표본추출을할수있으며이런차이로 는 TD OCT 에비해망막내구조를더자세하게보여줄수있다. 9,10 375

5 - 대한안과학회지 2010 년제 51 권제 3 호 - 일반적으로변동계수가 10% 미만일때신뢰할수있는검사로인정되며, 15,16 TD OCT 인 Stratus OCT 로측정한황반두께가신뢰할수있다는보고는많이있다. 6-8 저자들은이미정상안을대상으로한연구에서 Stratus OCT 에서측정된황반두께의변동계수는 1.01%~2.78%, 급내상관계수는 0.78~0.96이었고, 인 Spectralis OCT에서의변동계수는 1% 미만이었고, 급내상관계수는 0.92~0.99로 는 TD OCT 인에비해더높은반복성을보인다는사실을보고하였다 그러나 의빠른속도와높은해상도가정상안이아닌황반부종등과같은여러가지황반질환에서의황반두께측정에있어서더높은신뢰도를보일지에대한평가는아직까지정확하게이루어지지않다. 이번연구에서 Stratus OCT 에서측정된황반두께의변동계수는 2.11~4.12% 이었고, 급내상관계수는 0.78~0.94 이었다. 이에비해 Spectralis OCT에서의변동계수는황반두께측정에서 1.17~2.14% 이었고, 급내상관계수는 0.90~ 0.96으로 인 Spectralis OCT 가 TD OCT 인 Stratus OCT에비해더높은반복성을보였다. Spectralis OCT로측정한중심와두께, 총황반두께, 총황반부피는각각 427.6±147.4 μm 367.0±100.0 μm, 10.0± 1.6 mm 3 로 Stratus OCT 로측정한 367.2±155.0 μm, ±96.6 μm, 8.6±1.7 mm 3 에비해통계적으로유의하게높았다. Spectralis OCT의황반두께측정치가 Stratus OCT 에비해더높음에도불구하고개체내분산 (within-subject variances) 은통계적으로의미있게낮았다. 이와같이 인 Spectralis OCT가더높은반복성을보이는이유는 TD OCT 에비해훨씬빨라진스캔속도, 더많은표본추출밀도 (higher sampling density) 및 Spectralis OCT에있는특별한기능인 dual beam system, 즉, 시선추적 (eye tracking) 기능에의한것으로볼수있다. 중심황반두께를 400 μm를기준으로두군으로나누어두 OCT간반복성을비교해보았는데, 400 μm 미만인군과 400 μm 이상인군에서의변동계수는 TD OCT 에서각각 2.48% 와 3.07%, 에서는 1.38% 와 1.72% 로중심황반두께가 400 μm 이상인경우반복성이유의하게낮았다. 이러한결과는황반부종이심할수록환자의주시가불량하기때문인것으로생각된다. 따라서 는많은장점으로인해 TD OCT 에비해더높은반복성을보이기는하지만황반부종이심할수록반복성이떨어진다는사실을알수있었다. 이러한결과로볼때 로황반두께측정시빠른스캔속도와표본추출밀도뿐만아니라환자의주시도반복성의주요결정변수중하나로볼수있다. 본연구에서전체및구역별황반두께와총황반부피는 에서통계적으로유의하게더높게측정되었는데, 그이유는황반두께의측정기준이두 OCT가다르기때문이다. Stratus OCT는황반두께측정에있어유리체-망막면에서시세포층의내 / 외절연접부사이의거리를기준으로하나, Spectralis OCT는유리체-망막면에서브루크막을경계로하기때문이다. 즉, 두 OCT 사이의황반두께의차이는황반부시세포외절과망막색소상피 (retinal pigment epithelium, RPE) 의두께에상응하는값으로생각할수있다. 정상안에서시세포외절의길이는 50 μm이고, 17 RPE의두께는 11.3 μm 정도로알려져있다. 18 본연구에서나타난두 OCT의구역별황반두께차이는 53.7~67.0 μm 로황반부종이있기는하지만정상안에서의시세포외절길이와 RPE 두께에상응하는범위를보였다. 이처럼두 OCT는황반두께를측정할때그기준면이다르므로여기서얻은황반두께의측정치는당뇨황반부종에서서로다르며일치도가낮을수밖에없다. 이는저자들이보고한정상안에서두 OCT는서로다른일치도를보인다는결과와유사하며당뇨황반부종에서도 Stratus OCT에서측정된황반두께와부피는 Spectralis OCT의측정결과와상호교환될수는없다는것을의미한다. 그러나모든황반두께및총황반부피에서측정한두 OCT 사이의 Pearson 상관계수는 0.88에서 0.99로모두통계적으로유의하였다. 이러한결과는두 OCT로측정했을때그결과들은직접적으로상호교환적이지는못하지만두 OCT 간의측정치를간접적으로알수있고, 이를통해당뇨황반부종치료전후, 혹은경과관찰시황반두께의추이를알아보는데는상호도움이될수있다는점을시사한다. 결론적으로본연구에서저자들은 TD OCT 인 Stratus OCT와 인 Spectralis OCT는황반두께와총황반부피측정치의차이가있음에도두 OCT 모두당뇨황반부종환자의황반부측정에있어높은반복성을보였으며 Spectralis OCT에서유의하게더높았다. 황반측정값은 Spectralis OCT에서 Stratus OCT 에비해더높게측정되었고, 두 OCT는낮은일치도를보여상호교환적이지는않았으나, 두 OCT간유의한상관관계를보였다. 앞으로저자들은여러황반질환환자들을대상으로 SD OCT의임상적인유용성에대한추가적인연구를시행할예정이다. 참고문헌 1) Zeimer RC, Mori MT, Khoobehi B. Feasibility test of a new method to measure retinal thickness noninvasively. Invest Ophthalmol Vis Sci 1989;30:

6 - 오세범외 : 의통계적반복성과일치도 - 2) Gieser JP, Rusin MM, Mori M, et al. Clinical assessment of the macular by retinal topography and thickness mapping. Am J Ophthalmol 1997;124: ) Polito A, Shah SM, Haller JA, et al. Comparision between retinal thickness analyzer and optical coherence tomography for assessment of foveal thickness in eyes with macular disease. Am J Ophthalmol 2002;134: ) Puliafito CA, Hee MR, Schuman JS, et al. Optical coherence tomography of ocular disease. Thorofare, NJ: Slack, 1996; ) Muscat S, Parks S, Kemp E, Keating D. Repeatability and reproducibility of macular thickness measurements with the Humphrey system. Invest Ophthalmol Vis Sci 2002;43; ) Gurses-Ozden R, Teng C, Vessani R, et al. Macular and retinal nerve fiber layer thickness measurement reproducibility using optical coherence tomography (OCT-3). J Glaucoma 2004;13: ) Paunescu LA, Schuman JS, Price LL, et al. Reproducibility of nerve fiber thickness, macular thickness, and optic nerve head measurements using Stratus OCT. Invest Ophthalmol Vis Sci 2004;45: ) Polito A, Del Borrello M, Isola M, et al. Repeatability and reproducibility of fast macular thickness mapping with Stratus optical coherence tomography. Arch Ophthalmol 2005;123: ) Hangai M, Ojima Y, Gotoh N, et al. Three-dimensional imaging of macular holes with high-speed optical coherence tomography. Ophthalmology 2007;114: ) Ahlers C, Michels S, Beckendorf A, et al. Three-dimensional imaging of pigment epithelial detachment in age-related macular degeneration using optical coherence tomography, retinal thickness analysis and topographic angiography. Graefes Arch Clin Exp Ophthalmol 2006;244: ) Leung CK, Cheung CY, Weinreb RN, et al. Comparison of macular measurements between time domain and specral domain optical coherence tomography. Invest Ophthalmol Vis Sci 2008;49: ) Oh SB, Cho WB, Moon JW, Kim HC, et al. Repeatability and agreement of macular thickness measurement using time domain OCT and spectral domain OCT in normal subjects. J Korean Ophthalmol Soc 2009;50: ) Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: ) Bland JM. Comparing within-subject variances in a study to compare two methods of measurement. Available at york.ac.uk/~mb55/meas/compsd.pdf. 15) Massin P, Vicaut E, Haouchine B, et al. Reproducibility of retinal mapping using optical coherence tomography. Arch Ophthalmol 2001;119: ) Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Pshychol Bull 1979:86: ) Hendrickson A, Drucker D. The development of parafoveal and mid-peripheral human retina. Behav Brain Res 1992;49: ) Spraul CW, Lang GE, Grossniklaus HE. Morphometric analysis of the choroid, Bruch's membrane, and retinal pigment epithelium in eyes with age-related macular degeneration. Invest Ophthalmol Vis Sci 1996;37:

7 - 대한안과학회지 2010 년제 51 권제 3 호 - =ABSTRACT= Repeatability and Agreement of Macular Measurement Using Time and Spectral Domain OCT in Diabetic Macular Edema Se Beum Oh, MD, Jun Woong Moon, MD, Hyung Chan Kim, MD, PhD Department of Ophthalmology, Konkuk University School of Medicine, Seoul, Korea Purpose: To evaluate the repeatability of macular thickness measurements using time domain (TD) OCT and spectral domain (SD) OCT in diabetic macular edema. Methods: In 42 eyes of 42 patients with diabetic macular edema, three consecutive macular measurements were performed with TD OCT and, and measurements for macular thickness and total macular volume obtained by the two OCTs were compared. The within-subject standard deviation (Sw), coefficient of variation (CVw), and intraclass correlation coefficient (ICC) were calculated to assess repeatability, with agreement between measurements assessed with Bland Altman plots. The correlations were also evaluated via the Pearson s correlation coefficient. Results: The Sw of TD OCT and for foveal thickness, total macular volume were μm/16.44 μm, 1.26 mm 3 /0.23 mm 3, respectively, and were significantly lower in. The ranges of the respective CVw and ICC values were %, 0.78~0.96 for TD OCT, and 0.29~0.94%, 0.92~0.99 for. The showed better repeatability for macular thickness measurements (all p 0.001). The 95% limits of agreement for foveal and total macular volume were 88.9 μm, 2.4 mm 3, respectively. The Pearson s correlation coefficients of macular thickness and total macular volume between the two OCT methods were statistically significant (p= ). Conclusions: Although both OCTs proved reliable for macular thickness measurements in diabetic macular edema, shows better repeatability than TD OCT. Although macular thickness measurements obtained from the two OCTs cannot be used interchangeably, there were statistically significant correlations between measurements obtained using the two OCTs. J Korean Ophthalmol Soc 2010;51(3): Key Words: Coefficient of variation, Intraclass correlation coefficient, Spectral domain OCT, Time domain OCT, Within-subject standard deviation Address reprint requests to Hyung Chan Kim, MD, PhD Konkuk University Medical Center, Konkuk University School of Medicine #4-12 Hwayang-dong, Gwangjin-gu, Seoul , Korea Tel: , Fax: , eyekim@kuh.ac.kr 378

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