Pauleikhoff Daniel, Radermacher Martin, Spital Georg, Müller Christian, Brumm Gabriele, Lommatzsch Albrecht, Bird Alan C
Department of Ophthalmology, St. Franziskus Hospital, Hohenzollernring 74, 48145 Münster, Germany.
Graefes Arch Clin Exp Ophthalmol. 2002 Jul;240(7):539-42. doi: 10.1007/s00417-002-0507-6. Epub 2002 Jun 27.
A prospective longitudinal study was initiated to analyze the correlation between the prognosis for the second eyes of patients with unilateral late exudative AMD and the disease phenotype.
Of the187 patients with unilateral late exudative AMD recruited, 130 (69.5%) had predominantly classic CNV without pigment epithelium detachment (PED) (CNV group), and 57 (30.5%) had occult CNV with serous PED (PED group). Patients were reexamined by ophthalmoscopy and angiography every 6 months for up to 80 months. The end point was ETDRS visual acuity change of 3 lines or more due to late AMD in the second eye.
During follow-up 53 (28.3%) patients reached the end point: 32 (24.6%) in the CNV group and 21 (36.8%) in the PED group. The major prognostic factor for the risk of visual loss in the second eye was the type of late AMD in the first eye (CNV group 6-7% per year, PED group 15-16% per year ( P<0.001). There was significant symmetry between the new exudative lesion in the second eye and that in the first, and significant differences in the density and fluorescence of drusen in the second eye between the two groups.
Patients with occult CNV with serous PED in the first eye have a significantly higher risk of visual loss in the second eye than patients with CNV without PED. This distinction may be important for future clinical studies. In addition, segregation of AMD by phenotype is necessary in the analysis of genes conferring risk of AMD.
开展一项前瞻性纵向研究，以分析单侧晚期渗出性年龄相关性黄斑变性（AMD）患者对侧眼的预后与疾病表型之间的相关性。
在招募的187例单侧晚期渗出性AMD患者中，130例（69.5%）主要为典型性脉络膜新生血管（CNV）且无色素上皮脱离（PED）（CNV组），57例（30.5%）为隐匿性CNV伴浆液性PED（PED组）。患者每6个月接受一次检眼镜检查和血管造影检查，最长随访80个月。终点为对侧眼因晚期AMD导致ETDRS视力下降3行或更多。
随访期间，53例（28.3%）患者达到终点：CNV组32例（24.6%），PED组21例（36.8%）。对侧眼视力丧失风险的主要预后因素是患眼的晚期AMD类型（CNV组每年6 - 7%，PED组每年15 - 16%，P<0.001）。对侧眼新出现的渗出性病变与患眼的病变之间存在显著对称性，两组对侧眼玻璃膜疣的密度和荧光存在显著差异。
与无PED的CNV患者相比，第一眼为隐匿性CNV伴浆液性PED的患者对侧眼视力丧失风险显著更高。这种差异可能对未来的临床研究很重要。此外，在分析赋予AMD风险的基因时，按表型对AMD进行分类是必要的。
