Wong Tien Y, Chakravarthy Usha, Klein Ronald, Mitchell Paul, Zlateva Gergana, Buggage Ronald, Fahrbach Kyle, Probst Corey, Sledge Isabella
Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
Ophthalmology. 2008 Jan;115(1):116-26. doi: 10.1016/j.ophtha.2007.03.008. Epub 2007 Aug 6.
To describe the natural history and progression of visual loss in eyes with untreated neovascular age-related macular degeneration (AMD).
Systematic review and meta-analysis.
Four thousand three hundred sixty-two untreated neovascular AMD patients from published interventional studies.
A systematic review of the literature from 1980 to August 2005 was performed. Studies reporting disease progression outcomes for untreated patients with neovascular AMD were included. Outcome measures were summarized using simple counts and means. Random effects meta-analyses were conducted and tests of heterogeneity were performed where appropriate.
Changes in visual acuity (VA) loss, development of comorbidities, and fellow eye involvement.
Fifty-three primary studies were included. Nearly half of the studies (28) were randomized clinical trials. The quality of the studies was high, with over 80% providing level I or II evidence. Mean baseline VA among study patients was 0.64 logarithm of the minimum angle of resolution (logMAR) (approximately 20/87 Snellen). The mean VA change in logMAR progressed from 0.1 (1 line lost) at 3 months to 0.3 (2.7 lines lost) after 12 months and 0.4 (4 lines lost) after 24 months. The proportion of patients who developed severe vision loss (>6 lines) from baseline increased from 21.3% at 6 months to 41.9% by 3 years. The proportion of patients with VA worse than logMAR 1.0 (20/200 Snellen) increased from 19.7% at baseline to 75.7% by 3 years. Neovascular AMD developed in the fellow eye in 12.2% of patients by 12 months and in 26.8% by 4 years. Meta-analyses of vision outcome by subtype of neovascular AMD were not possible.
A doubling of the visual angle of presenting VA may be expected to occur in the year after initial presentation in eyes with untreated neovascular AMD. No conclusions can be drawn as to the differences in rates of disease progression by neovascular AMD subtype. The diversity of reporting formats, paucity of long-term natural history data, and heterogeneity among the reported clinical studies impose limits to the clear understanding of long-term prognosis for visual function in neovascular AMD.
描述未经治疗的新生血管性年龄相关性黄斑变性（AMD）患者视力丧失的自然病史和进展情况。
系统评价和荟萃分析。
来自已发表的干预性研究的4362例未经治疗的新生血管性AMD患者。
对1980年至2005年8月的文献进行系统评价。纳入报告未经治疗的新生血管性AMD患者疾病进展结果的研究。使用简单计数和均值总结结局指标。进行随机效应荟萃分析，并在适当情况下进行异质性检验。
视力（VA）丧失的变化、合并症的发生以及对侧眼受累情况。
纳入53项主要研究。近一半的研究（28项）为随机临床试验。研究质量较高，超过80%提供了I级或II级证据。研究患者的平均基线VA为最小分辨角对数（logMAR）0.64（约20/87 Snellen）。logMAR的平均VA变化从3个月时的0.1（视力下降1行）进展到12个月时的0.3（视力下降2.7行）和24个月时的0.4（视力下降4行）。从基线开始出现严重视力丧失（>6行）的患者比例从6个月时的21.3%增加到3年时的41.9%。VA比logMAR 1.0（20/200 Snellen）差的患者比例从基线时的19.7%增加到3年时的75.7%。12个月时，12.2%的患者对侧眼发生新生血管性AMD，4年时为26.8%。无法对新生血管性AMD亚型的视力结局进行荟萃分析。
未经治疗的新生血管性AMD患者在初次就诊后的一年内，预计其就诊时VA的视角会翻倍。关于新生血管性AMD亚型的疾病进展率差异无法得出结论。报告格式的多样性、长期自然病史数据的匮乏以及所报告临床研究之间的异质性限制了对新生血管性AMD视觉功能长期预后的清晰理解。
