视网膜形态对新生血管性年龄相关性黄斑变性患者对比敏感度和阅读能力的影响。
Effects of retinal morphology on contrast sensitivity and reading ability in neovascular age-related macular degeneration.
机构信息
Doheny Image Reading Center, Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
出版信息
Invest Ophthalmol Vis Sci. 2010 Nov;51(11):5431-7. doi: 10.1167/iovs.09-4846. Epub 2010 Jun 16.
PURPOSE
To investigate the effect of changes in retinal morphology on contrast sensitivity and reading ability in patients with neovascular age-related macular degeneration (AMD) in the Avastin (bevacizumab; Genentech, South San Francisco, CA) for choroidal neovascularization (ABC) Trial.
METHODS
Contrast sensitivity obtained with Pelli-Robson charts, reading ability assessed with Minnesota Reading charts, and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) obtained by protocol refraction, were recorded. Raw Stratus optical coherence tomography (OCT; Carl Zeiss Meditec, Inc., Dublin, CA) images were analyzed with the publicly available software OCTOR, which allows precise delineation of any retinal compartment of interest. Thickness and volume were calculated for neurosensory retina, subretinal fluid (SRF), subretinal tissue, and pigment epithelium detachment, and the resulting measurements were correlated with each visual function parameter.
RESULTS
One hundred twenty-two patients with newly diagnosed neovascular AMD and enrolled in the ABC Trial, were evaluated. Increased subretinal tissue volume correlated with decreased contrast sensitivity (Pearson's correlation coefficient, r = -0.4944, P = 0.001). A modest correlation was detected between SRF volume and contrast sensitivity (r = -0.2562, P = 0.004). Increased retinal thickness at the foveal center also correlated with decreased visual function (ETDRS VA: r = -0.4530, P < 0.001).
CONCLUSIONS
The strongest correlation detected between the functional parameters assessed and any of the OCT-derived morphologic parameters was that between decreased contrast sensitivity and increased subretinal tissue. In the future, assessment of contrast sensitivity and reading ability, in combination with quantitative subanalysis of retinal compartments, may lead to the identification of parameters relevant to functional improvement and ultimate prognosis in patients with newly diagnosed neovascular AMD (www.controlled-trials.com number, ISRCTN83325075).
目的
探讨抗血管内皮生长因子（Avastin，贝伐单抗；基因泰克，旧金山南部，加利福尼亚州）治疗脉络膜新生血管（ABC）试验中新生血管性年龄相关性黄斑变性（AMD）患者视网膜形态变化对对比敏感度和阅读能力的影响。
方法
用 Pelli-Robson 图表记录对比敏感度，用明尼苏达阅读图表记录阅读能力，用协议折射获得早期治疗糖尿病视网膜病变研究（ETDRS）视力（VA）。用公开可用的软件 OCTOR 分析 Stratus 光学相干断层扫描（OCT；卡尔蔡司 Meditec，Inc.，都柏林，加利福尼亚州）的原始图像，该软件允许精确划定任何感兴趣的视网膜区域。计算神经感觉视网膜、视网膜下液（SRF）、视网膜下组织和色素上皮脱离的厚度和体积，并将测量结果与每个视觉功能参数相关联。
结果
评估了新诊断为新生血管性 AMD 并参加 ABC 试验的 122 例患者。视网膜下组织体积增加与对比敏感度降低相关（Pearson 相关系数，r = -0.4944，P = 0.001）。检测到 SRF 体积与对比敏感度之间存在适度相关性（r = -0.2562，P = 0.004）。黄斑中心视网膜厚度增加也与视力下降相关（ETDRS VA：r = -0.4530，P < 0.001）。
结论
在所评估的功能参数与任何 OCT 衍生形态参数之间检测到的最强相关性是对比敏感度降低与视网膜下组织增加之间的相关性。在未来，对比敏感度和阅读能力的评估，结合对视网膜各层的定量亚分析，可能会确定与新诊断的新生血管性 AMD 患者功能改善和最终预后相关的参数（www.controlled-trials.com 编号，ISRCTN83325075）。
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