Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany.
Ophthalmology. 2010 Jun;117(6):1169-76. doi: 10.1016/j.ophtha.2009.10.044. Epub 2010 Feb 16.
To determine microstructural retinal alterations associated with reticular drusen in patients with age-related macular degeneration (AMD) using high-resolution in vivo imaging techniques.
Retrospective case series.
A total of 116 eyes of 78 AMD patients with reticular drusen were examined.
Simultaneous spectral-domain optical coherence tomography (SD OCT; 870 nm, 40,000 A-scans/sec) and near-infrared confocal scanning laser ophthalmoscopy (cSLO; 830 nm) were performed using a combined imaging instrument (Spectralis HRA+OCT, Heidelberg Engineering, Heidelberg, Germany). Individual anatomic layers in SD OCT were evaluated and correlated to en face cSLO fundus imaging.
Description of corresponding structural changes in areas of reticular drusen.
Reticular drusen appeared as an interlacing network of round or oval irregularities by near-infrared cSLO reflectance imaging. On SD OCT, reticular drusen corresponded to marked changes at a level anterior to the retinal pigment epithelium (RPE) and Bruch's membrane complex to the interface of inner and outer photoreceptor segment layer (IPRL). Individual reticular drusen correlated to focal elevations of the IPRL, accumulation of highly reflective material below the IPRL, and an increased distance between the IPRL and RPE.
The findings indicate that the morphologic substrate of reticular drusen is the accumulation of highly reflective material within outer retinal layers anterior to the RPE. This is in contrast to previous assumptions pointing toward a localization of abnormal material at the level of the inner choroid. Although the origin of the material is unknown, the results may indicate a role for primary abnormalities in the neurosensory retina. Because reticular drusen represent high-risk markers for the progression of AMD, their ready identification is relevant both for natural history studies as well as for interventional trials.
利用高分辨率活体成像技术，确定与年龄相关性黄斑变性（AMD）患者中网状玻璃膜疣相关的视网膜微观结构改变。
回顾性病例系列。
共检查了 78 例 AMD 患者共 116 只眼的网状玻璃膜疣。
使用联合成像仪器（Spectralis HRA+OCT，Heidelberg Engineering，德国海德堡）同时进行频域光学相干断层扫描（SD OCT；870nm，40000A 扫描/秒）和近红外共焦扫描激光检眼镜（cSLO；830nm）。在 SD OCT 中评估单个解剖层，并与共焦眼底成像的正面 cSLO 进行相关性分析。
描述网状玻璃膜疣区域相应的结构变化。
通过近红外 cSLO 反射成像，网状玻璃膜疣表现为圆形或椭圆形不规则的交织网络。在 SD OCT 上，网状玻璃膜疣对应于视网膜色素上皮（RPE）前的视网膜层和 Bruch 膜复合体到内、外光感受器节段层（IPRL）交界处的明显变化。单个网状玻璃膜疣与 IPRL 的局灶性隆起、IPRL 下方高反射物质的积聚以及 IPRL 和 RPE 之间距离的增加有关。
这些发现表明，网状玻璃膜疣的形态学基础是 RPE 前外层视网膜中高度反射物质的积聚。这与先前指向内脉络膜水平异常物质定位的假设形成对比。尽管物质的来源尚不清楚，但结果可能表明原发性神经感觉视网膜异常的作用。由于网状玻璃膜疣是 AMD 进展的高风险标志物，因此它们的易于识别对于自然史研究和干预试验都具有相关性。
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