Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Germany.
Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
Ophthalmology. 2013 Dec;120(12):2656-2665. doi: 10.1016/j.ophtha.2013.05.029. Epub 2013 Jul 4.
To use spectral domain optical coherence tomography (SD-OCT) to investigate risk factors predictive for the development of atrophy of drusenoid lesions (DLs) (drusen and drusenoid pigment epithelium detachment) in eyes with non-neovascular age-related macular degeneration (NNVAMD).
Cohort study.
Forty-one eyes from 29 patients with NNVAMD.
Patients with NNVAMD who underwent registered SD-OCT imaging over a minimum period of 6 months were reviewed. Drusenoid lesions that were accompanied by new atrophy onset at 6 months or last follow-up (FUL) were further analyzed. Detailed lesion change was described throughout the study period. Odds ratios (ORs) and risk for new local atrophy onset were calculated.
Drusenoid lesion features and longitudinal changes in features, including maximum lesion height, lesion diameter, lesion internal reflectivity, and presence and extent of overlying intraretinal hyperreflective foci (HRF). Subfoveal choroidal thickness (SFCT) and choroidal thickness (CT) were measured below each lesion.
A total of 543 individual DLs were identified at baseline, and 28 lesions developed during follow-up. The mean follow-up time was 21.3±8.6 months (range, 6-44 months). Some 3.2% of DLs (18/571) progressed to atrophy within 18.3 ± 9.5 months (range, 5-28 months) of the initial visit. Drusenoid lesions with heterogeneous internal reflectivity were significantly associated with new atrophy onset at 6 months (OR, 5.614; 95% confidence interval [CI], 1.277-24.673) and new atrophy onset at FUL (OR, 7.005; 95% CI, 2.300-21.337). Lesions with the presence of HRF were significant predictors of new atrophy onset at 6 months (OR, 30.161; 95% CI, 4.766-190.860) and FUL (OR, 11.211; 95% CI, 2.513-50.019). Lesions with a baseline maximum height >80 μm or CT ≤ 135 μm showed a positive association with the new atrophy onset at FUL (OR, 7.886; 95% CI, 2.105-29.538 and OR, 3.796; 95% CI, 1.154-12.481, respectively).
The presence of HRF overlying DLs, a heterogeneous internal reflectivity of these lesions, was found consistently to be predictive of local atrophy onset in the ensuing months. These findings provide further insight into the natural history of anatomic change occurring in patients with NNVAMD.
使用谱域光相干断层扫描（SD-OCT）研究非新生血管性年龄相关性黄斑变性（NNVAMD）患者中预测 drusenoid 病变（DL）（包括 drusen 和 drusenoid 色素上皮脱离）发生萎缩的风险因素。
队列研究。
29 名 NNVAMD 患者的 41 只眼。
对接受了至少 6 个月的注册 SD-OCT 成像的 NNVAMD 患者进行了回顾性分析。对 6 个月或最后一次随访（FUL）时出现新萎缩的伴发新萎缩起始的 drusenoid 病变进行了进一步分析。在整个研究期间描述了详细的病变变化。计算了新局部萎缩起始的优势比（OR）和风险。
drusenoid 病变特征和特征的纵向变化，包括最大病变高度、病变直径、病变内部反射率以及是否存在和病变上方的视网膜内高反射焦点（HRF）的范围。在每个病变下方测量了中心凹下脉络膜厚度（SFCT）和脉络膜厚度（CT）。
在基线时共发现了 543 个单独的 DL，在随访期间有 28 个病变发展。平均随访时间为 21.3±8.6 个月（范围 6-44 个月）。在初始就诊后 18.3±9.5 个月（范围 5-28 个月）内，有 3.2%（18/571）的 DL 进展为萎缩。具有异质内部反射率的 drusenoid 病变与 6 个月时的新萎缩起始（OR，5.614；95%置信区间[CI]，1.277-24.673）和 FUL 时的新萎缩起始（OR，7.005；95%CI，2.300-21.337）显著相关。存在 HRF 的病变是 6 个月时新萎缩起始（OR，30.161；95%CI，4.766-190.860）和 FUL 时新萎缩起始（OR，11.211；95%CI，2.513-50.019）的显著预测因素。基线最大高度＞80 μm 或 CT≤135 μm 的病变与 FUL 时的新萎缩起始呈正相关（OR，7.886；95%CI，2.105-29.538 和 OR，3.796；95%CI，1.154-12.481）。
病变上方存在 HRF、这些病变的异质内部反射率与随后几个月的局部萎缩起始一致，提示存在预测作用。这些发现为 NNVAMD 患者发生的解剖结构变化的自然史提供了进一步的认识。
