CAPT Coordinating Center, University of Pennsylvania, Philadelphia, PA 19104-3309, USA.
Ophthalmology. 2008 Sep;115(9):1474-9, 1479.e1-6. doi: 10.1016/j.ophtha.2008.03.008. Epub 2008 May 27.
To determine risk factors for choroidal neovascularization (CNV) and of geographic atrophy (GA) in eyes with large drusen.
Cohort study within a multicenter, randomized clinical trial of laser treatment for the prevention of vision loss from advanced age-related macular degeneration.
One thousand fifty-two participants with 10 or more large drusen (>or=125 microm) and visual acuity of 20/40 or better in each eye.
At baseline, participants provided a brief medical history. Trained readers evaluated baseline color photographs for drusen characteristics and pigmentary abnormalities. One eye of each participant was assigned to laser treatment and the contralateral eye was assigned to observation. The Complications of Age-Related Macular Degeneration Prevention Trial (CAPT) Reading Center readers identified CNV and endpoint GA from color photographs and fluorescein angiograms obtained during follow-up visits scheduled for 5 or 6 years. Estimates of relative risks (RRs) and 95% confidence intervals (CIs) were obtained from survival analyses of observed and treated eyes, considered separately and combined.
Development of CNV and of endpoint GA.
Choroidal neovascularization developed in 141 observed eyes and 141 treated eyes, including 57 patients affected bilaterally. Statistically significant risk factors for CNV in the multivariate model for all eyes were older age (RR, 2.81 [95% CI, 1.33-5.94] for >79 years vs. 50-59 years), cigarette smoking (RR, 1.98 [95% CI, 1.16-3.39] for current vs. never), and focal hyperpigmentation (RR, 1.84 [95% CI, 1.22-2.76] for >or=250 microm vs. none). Among eyes free of GA at baseline, endpoint GA developed in 61 observed eyes and in 58 treated eyes, including 29 patients affected bilaterally. Statistically significant risk factors for GA in the multivariate model for all eyes were older age (RR, 6.39 [95% CI, 1.64-24.9] for >79 years vs. 50-59 years), greater retinal area covered by drusen (RR, 5.10 [95% CI, 2.57-10.1] for >or=25% vs. <10%), retinal pigment epithelium (RPE) depigmentation (RR, 2.64 [95% CI, 1.26-5.53), and focal hyperpigmentation (RR, 10.4 [95% CI, 4.51-24.0] for >or=250 microm vs. none).
Among CAPT participants, increased age and focal hyperpigmentation were risk factors for the development of CNV and for GA. Cigarette smoking was significantly associated with CNV only, whereas retinal area covered by drusen and RPE depigmentation were associated significantly with GA only.
确定存在大玻璃膜疣的眼睛发生脉络膜新生血管（CNV）和地图样萎缩（GA）的危险因素。
在一项多中心随机临床试验（该试验采用激光治疗预防晚期年龄相关性黄斑变性导致的视力丧失）中进行队列研究。
1052名参与者，每只眼睛有10个或更多大玻璃膜疣（≥125微米）且视力为20/40或更好。
在基线时，参与者提供简要病史。经过培训的阅片者评估基线彩色照片的玻璃膜疣特征和色素异常情况。为每位参与者的一只眼睛分配激光治疗，对侧眼睛分配至观察组。年龄相关性黄斑变性预防试验（CAPT）阅片中心的阅片者从随访5或6年期间获得的彩色照片和荧光素血管造影中识别CNV和终点GA。相对风险（RRs）估计值和95%置信区间（CIs）通过对观察眼和治疗眼的生存分析分别及合并计算得出。
CNV和终点GA的发生情况。
141只观察眼和141只治疗眼发生了脉络膜新生血管，其中57例患者双眼受累。在所有眼睛的多变量模型中，CNV的统计学显著危险因素为年龄较大（79岁以上与50 - 59岁相比，RR为2.81 [95% CI，1.33 - 5.94]）、吸烟（当前吸烟者与从不吸烟者相比，RR为1.98 [95% CI，1.16 - 3.39]）以及局灶性色素沉着（≥250微米与无相比，RR为1.84 [95% CI，1.22 - 2.76]）。在基线时无GA的眼睛中，61只观察眼和58只治疗眼出现了终点GA，其中29例患者双眼受累。在所有眼睛的多变量模型中，GA的统计学显著危险因素为年龄较大（79岁以上与50 - 59岁相比，RR为6.39 [95% CI，1.64 - 24.9]）、玻璃膜疣覆盖的视网膜面积更大（≥25%与<10%相比，RR为5.10 [95% CI，2.57 - 10.1]）、视网膜色素上皮（RPE）色素脱失（RR为2.64 [95% CI，1.26 - 5.53]）以及局灶性色素沉着（≥250微米与无相比，RR为10.4 [95% CI，4.51 - 24.0]）。
在CAPT参与者中，年龄增加和局灶性色素沉着是CNV和GA发生的危险因素。吸烟仅与CNV显著相关，而玻璃膜疣覆盖的视网膜面积和RPE色素脱失仅与GA显著相关。
