Department of Ophthalmology, Kobe City Medical Center General Hospital, Japan.
Am J Ophthalmol. 2010 Jul;150(1):27-32.e1. doi: 10.1016/j.ajo.2010.02.012.
To evaluate status of the external limiting membrane (ELM) as a contributor of visual acuity (VA) in age-related macular degeneration (AMD).
Hospital-based, cross-sectional study.
We retrospectively reviewed spectral-domain optical coherence tomography images of 158 patients with AMD who had undergone photodynamic therapy and classified them based on the status of the ELM: absent, discontinuous, or complete. We simultaneously assessed foveal thickness, presence or absence of subretinal fluid/mass, presence or absence of subretinal pigment epithelium fluid/mass, status of the inner segment/outer segment (IS/OS) junction, and status of the intermediate line between the IS/OS junction and retinal pigment epithelium. Correlation coefficients between each parameter and VA were analyzed.
There was a strong correlation between ELM status and VA (r = -0.75, P < .001), and that was higher than that of the IS/OS (r = -0.69, P < .001). Multivariate analysis showed that ELM status is the most important factor for VA. Other parameters that correlated with VA included age, status of the intermediate line, and presence of subretinal or subretinal pigment epithelium fibrosis. Foveal thickness showed V-shaped correlation, with the dividing line around 200 mum.
ELM status may be more useful than is IS/OS status in evaluation of retinal morphology and function in patients with AMD.
评估年龄相关性黄斑变性（AMD）中外部限制膜（ELM）在视力（VA）中的作用。
基于医院的横断面研究。
我们回顾性地研究了 158 例接受光动力疗法的 AMD 患者的频域光学相干断层扫描图像，并根据 ELM 的状态将其分类：缺失、不连续或完整。我们同时评估了中心凹厚度、是否存在视网膜下积液/积血、是否存在视网膜下色素上皮积液/积血、内节/外节（IS/OS）连接的状态以及 IS/OS 连接与视网膜色素上皮之间的中间线的状态。分析了每个参数与 VA 之间的相关系数。
ELM 状态与 VA 之间存在很强的相关性（r = -0.75，P <.001），相关性高于 IS/OS （r = -0.69，P <.001）。多变量分析表明，ELM 状态是 VA 的最重要因素。与 VA 相关的其他参数包括年龄、中间线状态以及是否存在视网膜下或视网膜色素上皮纤维化。中心凹厚度呈 V 形相关，分界线约为 200 µm。
ELM 状态可能比 IS/OS 状态更能评估 AMD 患者的视网膜形态和功能。
