网状性黄斑病变的前瞻性研究。
A prospective study of reticular macular disease.
机构信息
Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, USA.
出版信息
Ophthalmology. 2011 Aug;118(8):1619-25. doi: 10.1016/j.ophtha.2011.01.029. Epub 2011 May 6.
PURPOSE
To determine the risk of progression to advanced age-related macular degeneration (AMD) conferred by reticular pseudodrusen (RPD), an imaging presentation of reticular macular disease (RMD), in high-risk fellow eyes of subjects with AMD and unilateral choroidal neovascularization (CNV) in a large, prospective study.
DESIGN
Cohort study.
PARTICIPANTS
Two hundred seventy-one subjects with AMD; 94 with RPD and 177 without RPD.
METHODS
Images from a cohort of 271 subjects with AMD in the Nutritional AMD treatment phase II (NAT 2) Study, a 3-year prospective study of subjects with unilateral CNV and large soft drusen in the fellow eye, were studied. The fellow eye, at high risk for advanced AMD developing, was the study eye. There were 5 visits per subject. Imaging at each visit consisted of color, red-free, and blue-light photography and fluorescein angiography. The images were analyzed for the presence of RPD, following disease progression throughout the 3-year study.
MAIN OUTCOME MEASURES
The development of advanced AMD (CNV or geographic atrophy).
RESULTS
For the 271 subjects who completed the full 3-year study, there was a significantly higher rate of advanced AMD (56% or 53/94) in fellow eyes with RPD at any visit compared with eyes without RPD (32% or 56/177; P < 0.0001, chi-square test; relative risk [RR], 1.8; 95% confidence interval [CI], 1.4-2.4). The chance of developing advanced AMD in the fellow eye in women with RPD (66%) was more than double that of women without RPD (30%; P < 0.00001; RR, 2.2; 95% CI, 1.6-3.1).
CONCLUSIONS
To the authors' knowledge, this is the first comprehensive prospective study of RMD, a distinct clinical phenotype of AMD that includes RPD. It provides strong confirmation that RMD, a disease entity with stereotypical presentations across imaging methods, is associated with a high risk of progression to advanced AMD, perhaps on an inflammatory or vascular basis. Reticular macular disease deserves wider recognition and consideration by clinicians caring for patients with AMD.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
目的
在一项大型前瞻性研究中，通过对患有 AMD 和单侧脉络膜新生血管（CNV）的受试者的高风险对侧眼进行研究，确定网状假性小体（RPD）——网状黄斑疾病（RMD）的影像学表现——对视功能进展为晚期年龄相关性黄斑变性（AMD）的风险。
设计
队列研究。
参与者
271 名 AMD 受试者；94 名有 RPD，177 名无 RPD。
方法
对营养性 AMD 治疗二期（NAT2）研究中的 271 名 AMD 受试者的队列进行了研究，该研究是一项为期 3 年的前瞻性研究，研究对象为单侧 CNV 和对侧大软玻璃膜疣。高风险的对侧眼为研究眼。每位受试者有 5 次就诊。每次就诊时的影像学检查包括彩色、无红色和蓝光摄影以及荧光素血管造影。在整个 3 年的研究过程中，根据疾病进展情况分析图像中是否存在 RPD。
主要观察指标
晚期 AMD（CNV 或地理萎缩）的发生。
结果
在完成完整 3 年研究的 271 名受试者中，任何时候有 RPD 的对侧眼（56%，94/177）的晚期 AMD 发生率显著高于无 RPD 的对侧眼（32%，56/177；P<0.0001，卡方检验；相对风险[RR]，1.8；95%置信区间[CI]，1.4-2.4）。有 RPD 的女性（66%）发生晚期 AMD 的几率是无 RPD 的女性（30%）的两倍多（P<0.00001；RR，2.2；95%CI，1.6-3.1）。
结论
据作者所知，这是对 RMD 的首次全面前瞻性研究，RMD 是一种明确的 AMD 临床表型，包括 RPD。它有力地证实，RMD 是一种具有典型影像学表现的疾病实体，与进展为晚期 AMD 的高风险相关，可能基于炎症或血管基础。RMD 值得临床医生更广泛地认识和考虑。
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参考文献之后可能有专有或商业披露。
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