一种新的视网膜色素上皮撕裂分级系统。

A new grading system for retinal pigment epithelial tears.

机构信息

Jules Stein Eye Institute, UCLA Geffen School of Medicine, Los Angeles, California, USA.

出版信息

Retina. 2010 Jul-Aug;30(7):1039-45. doi: 10.1097/IAE.0b013e3181cdf366.

DOI:10.1097/IAE.0b013e3181cdf366

PMID:20458264

Abstract

PURPOSE

The purpose of this study was to assess the prognostic value of a new grading system for retinal pigment epithelium (RPE) tears that developed after antivascular endo-thelial growth factor (VEGF) therapy for exudative age-related macular degeneration.

METHODS

The authors performed a retrospective review of consecutive eyes that developed an RPE tear after intravitreal injection of an anti-VEGF agent (pegaptanib, bevacizumab, or ranibizumab) within a 4.5-year period (January 2005 to January 2009) at a single center. Fundus photography, fluorescein angiography, and optical coherence topography were studied for each case of RPE tear, and using fluorescein angiography analysis, a measurement of greatest linear diameter (millimeter) was obtained and a grading scale devised. The grade of RPE tear was correlated with visual and anatomical outcomes and response to continued anti-VEGF therapy.

RESULTS

Twenty-one eyes from 20 patients were evaluated in this study. Retinal pigment epithelium tears were graded from one to four based on the greatest length in the vector direction of the tear and involvement of the fovea. Nineteen percent (n = 4) of eyes had Grade 1 tears (diameter smaller than 200 microm), 14% (n = 3) had Grade 2 tears (diameter between 200 microm and 1-disk diameter), 19% (n = 4) had Grade 3 tears (diameter greater than 1-disk diameter), and 48% (n = 10) had Grade 4 tears (Grade 3 tears that involved the foveal center). Lower grade tears were more likely to have better visual acuity and better response to continued anti-VEGF therapy and less likely to develop a disciform scar but were at risk of progressing to a higher grade tear over time.

CONCLUSION

The grading of RPE tears according to greatest linear diameter may have prognostic value in predicting visual acuity and anatomical outcome with or without continued anti-VEGF therapy. Lower grade tears have better visual acuity and response to anti-VEGF therapy. Grade 4 tears have a very poor prognosis with or without anti-VEGF therapy.

摘要

目的

本研究旨在评估一种新的视网膜色素上皮（RPE）撕裂分级系统的预后价值，该分级系统是在单中心对接受抗血管内皮生长因子（VEGF）治疗渗出性年龄相关性黄斑变性的患者进行玻璃体腔内注射后发生的。

方法

作者对 2005 年 1 月至 2009 年 1 月期间在单中心接受抗 VEGF 药物（贝伐单抗、雷珠单抗或康柏西普）治疗后发生 RPE 撕裂的连续眼进行了回顾性研究。对每个 RPE 撕裂病例的眼底照相、荧光素血管造影和光学相干断层扫描进行了研究，通过荧光素血管造影分析获得最大线性直径（毫米）的测量值，并设计了一个分级量表。RPE 撕裂的分级与视力和解剖结果以及对持续抗 VEGF 治疗的反应相关。

结果

本研究共评估了 20 例 21 只眼。根据撕裂的向量方向上的最大长度和黄斑区的累及情况，将 RPE 撕裂分为 1 至 4 级。19%（n=4）的眼有 1 级撕裂（直径小于 200 微米），14%（n=3）有 2 级撕裂（直径在 200 微米和 1 个视盘直径之间），19%（n=4）有 3 级撕裂（直径大于 1 个视盘直径），48%（n=10）有 4 级撕裂（累及黄斑中心的 3 级撕裂）。较低级别的撕裂更有可能获得更好的视力和对持续抗 VEGF 治疗的更好反应，较少发生盘状瘢痕，但随着时间的推移，有进展为更高级别撕裂的风险。