Department of Ophthalmology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-3309, USA.
Ophthalmology. 2013 Sep;120(9):1871-9. doi: 10.1016/j.ophtha.2013.01.049. Epub 2013 Apr 25.
To characterize the size, location, conformation, and features of incident geographic atrophy (GA) as detected by annual stereoscopic color photographs and fluorescein angiograms (FAs).
Retrospective cohort study within a larger clinical trial.
Patients with bilateral large drusen in whom GA developed during the course of the Complications of Age-related Macular Degeneration Prevention Trial (CAPT).
Annual stereoscopic color photographs and FAs were reviewed from 114 CAPT patients in whom GA developed in the untreated eye during 5 to 6 years of follow-up. Geographic atrophy was defined according to the Revised GA Criteria for identifying early GA.(23) Color-optimized fundus photographs were viewed concurrently with the FAs during grading.
Size and distance from the fovea of individual GA lesions, number of areas of atrophy, and change in visual acuity (VA) when GA first developed in an eye.
At presentation, the median total GA area was 0.26 mm(2) (0.1 disc area). Geographic atrophy presented as a single lesion in 89 (78%) eyes. The median distance from the fovea was 395 μm. Twenty percent of incident GA lesions were subfoveal and an additional 18% were within 250 μm of the foveal center. Development of GA was associated with a mean decrease of 7 letters from the baseline VA level compared with 1 letter among matched early age-related macular degeneration eyes without GA. Geographic atrophy that formed in areas previously occupied by drusenoid pigment epithelial detachments on average were larger (0.53 vs. 0.20 mm(2); P = 0.0001), were more central (50 vs. 500 μm from the center of the fovea; P<0.0001), and were associated with significantly worse visual outcome (20/50 vs. 20/25; P = 0.0003) than GA with other drusen types as precursors.
Incident GA most often appears on color fundus photographs and FAs as a small, singular, parafoveal lesion, although a large minority of lesions are subfoveal or multifocal at initial detection. The characteristics of incident GA vary with precursor drusen types. These data can facilitate design of future clinical trials of therapies for GA.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
通过每年的立体彩色照片和荧光素血管造影（FA）来描述新发生的地图状萎缩（GA）的大小、位置、形态和特征。
一项更大临床试验中的回顾性队列研究。
在年龄相关性黄斑变性预防试验（CAPT）中，双侧有大的玻璃膜疣且在治疗过程中出现 GA 的患者。
对 114 名 CAP 患者进行了回顾性分析，这些患者在 5 至 6 年的随访中，未经治疗的眼睛出现了 GA。根据识别早期 GA 的修订 GA 标准（23）来定义 GA。（23）在分级过程中，同时观察彩色优化眼底照片和 FA。
单个 GA 病变的大小和距黄斑中心凹的距离、萎缩区的数量以及 GA 首次出现时视力（VA）的变化。
在出现时，GA 的中位总面积为 0.26mm²（0.1 个盘面积）。89 只（78%）眼的 GA 呈单个病变。距黄斑中心凹的中位距离为 395μm。20%的新 GA 病变位于黄斑中心凹下，另外 18%的病变距黄斑中心凹中心 250μm 以内。GA 的发生与基线 VA 水平相比平均下降了 7 个字母，而无 GA 的匹配早期年龄相关性黄斑变性眼仅下降了 1 个字母。形成于先前存在的玻璃膜疣样色素上皮脱离区域的 GA 平均较大（0.53mm²比 0.20mm²；P=0.0001），更靠近中心（距黄斑中心凹中心 50μm 比 500μm；P<0.0001），且与具有其他玻璃膜疣样前体类型的 GA 相比，视力结果更差（20/50 比 20/25；P=0.0003）。
新发生的 GA 通常在眼底彩色照片和 FA 上呈现为小的、单一的、旁中心凹病变，尽管少数病变在初始检测时为黄斑中心凹下或多灶性。新发生的 GA 的特征随前体玻璃膜疣类型而异。这些数据可以为 GA 治疗的未来临床试验设计提供帮助。
作者没有与本文讨论的材料有关的专有或商业利益。
