[年龄相关性黄斑变性中的色素上皮脱离——分类、鉴别与预后]

Brumm Gabriele, Spital Georg, Radermacher Martin, Lommatzsch Albrecht, Pauleikhoff Daniel

Augenabteilung St. Franziskus Hospital Münster.

Klin Monbl Augenheilkd. 2002 Nov;219(11):791-6. doi: 10.1055/s-2002-36320.

BACKGROUND

A pigment epithelial detachment (PED) is an exudative manifestation of late age-related macular degeneration (AMD). Its long-term unfavourable prognosis is influenced by the association of a neovascular membrane. Seemingly identical PEDs in ophthalmoscopy can be further differentiated by fluorescein and indocyanine green angiography. The purpose of this prospective follow-up study was to determine the most reliable angiographic classification to distinguish PEDs in AMD and to evaluate their outcome.

MATERIAL AND METHODS

73 eyes of 68 patients with a PED in AMD were examined with simultaneous angiography with fluorescein and indocyanine green. 34 eyes were additionally scanned by retinatomography. Fluorescein angiographic classification comprises 4 types: 1. early hyperfluorescent type, 2. late hyperfluorescent type, 3. drusen type, 4. irregular fluorescent type. Indocyanine green angiographic classification consists of the following three groups: 1. angiographically no vascularisation, 2. associated choroidal neovascularisation, 3. associated polypoidal choroidal vasculopathy.

RESULTS

Both classifications show statistically significant correlation with visual acuity (fluorescein classification: P = 0.0112, ICG-classification: P = 0.0004) and area of the PEDs (fluorescein classification: P = 0.0002, ICG-classification: P < 0.0001). ICG-classification additionally is significantly associated with the volume (P = 0.0008). Both classifications correlate (P = 0.0001). Factors influencing visual acuity are: age (P = 0.0044), associated neovascular membrane (P = 0.0004), area (P < 0.0001), volume (P = 0.0077) and height (P < 0.0001).

CONCLUSIONS

PEDs in AMD can best be classified by indocyanine green angiography on the basis of an associated prognostically important neovascular membrane, which can only be further distinguished into choroidal neovascularisation or polypoidal choroidal vasculopathy by indocyanine green angiography. Statistical analysis shows qualitatively and quantitatively more significant results for the indocyanine green angiographic classification.

背景

色素上皮脱离（PED）是晚期年龄相关性黄斑变性（AMD）的一种渗出性表现。其长期不良预后受新生血管膜的影响。眼底镜检查中看似相同的PED可通过荧光素和吲哚菁绿血管造影进一步区分。这项前瞻性随访研究的目的是确定区分AMD中PED的最可靠血管造影分类，并评估其结果。

材料与方法

对68例患有AMD的PED患者的73只眼进行了荧光素和吲哚菁绿同步血管造影检查。另外对34只眼进行了视网膜断层扫描。荧光素血管造影分类包括4种类型：1.早期高荧光型；2.晚期高荧光型；3.玻璃膜疣型；4.不规则荧光型。吲哚菁绿血管造影分类包括以下三组：1.血管造影无血管化；2.伴有脉络膜新生血管；3.伴有息肉样脉络膜血管病变。

结果

两种分类均显示与视力（荧光素分类：P = 0.0112，吲哚菁绿分类：P = 0.0004）和PED面积（荧光素分类：P = 0.0002，吲哚菁绿分类：P < 0.0001）具有统计学显著相关性。吲哚菁绿分类还与体积显著相关（P = 0.0008）。两种分类具有相关性（P = 0.0001）。影响视力的因素有：年龄（P = 0.0044）、伴有新生血管膜（P = 0.0004）、面积（P < 0.0001）、体积（P = 0.0077）和高度（P < 0.0001）。