Coscas Gabriel, Yamashiro Kenji, Coscas Florence, De Benedetto Umberto, Tsujikawa Akitaka, Miyake Masahiro, Gemmy Cheung Chui Ming, Wong Tien Yin, Yoshimura Nagahisa
Centre d'Ophtalmologie de Paris, Paris, France; Department of Ophthalmology, University Paris-Est Créteil, Paris XII, Creteil, France.
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Am J Ophthalmol. 2014 Aug;158(2):309-318.e2. doi: 10.1016/j.ajo.2014.05.004. Epub 2014 May 17.
To compare and analyze differences and similarities between Japanese and French patients in subtype diagnosis of exudative age-related macular degeneration (AMD) as determined by fundus photography (FP) and fluorescein angiography (FA), and a multimodal imaging involving FP, FA, indocyanine green angiography (ICGA), and optical coherence tomography (OCT).
Retrospective chart review.
We determined the subtype diagnosis for 99 consecutive Japanese eyes and 94 consecutive French eyes with exudative AMD. The first-step diagnosis was made using FP and FA, while the second-step diagnosis was made using FP, FA/ICGA, and OCT. The diagnoses made by Japanese and French physicians were compared, and when the diagnoses differed, a third institute was consulted to arrive at a final consensus and diagnosis.
The first-step diagnosis showed 20%-30% disagreement against the final diagnosis, but the second-step diagnosis showed only 10% disagreement. Polypoidal choroidal vasculopathy (PCV) was observed more in Japanese patients (48%) than in French (9%), and the rate of PCV with type 1 or 2 choroidal neovascularization (CNV) was extremely low: 3% in Japanese and 0% in French. Type 1 CNV was found significantly more in French cases (53.3% vs 35.1%, P=.018), while the rate of eyes with type 2 CNV only or chorioretinal anastomosis was similar between populations.
Multimodality imaging significantly improved the sub-classification of AMD. There were significant differences between the 2 series in the proportions of type 1 CNV and PCV, while the proportions of type 2 CNV only and chorioretinal anastomosis were similar between groups.
通过眼底照相（FP）、荧光素血管造影（FA）以及包括FP、FA、吲哚菁绿血管造影（ICGA）和光学相干断层扫描（OCT）的多模态成像，比较和分析日本和法国渗出性年龄相关性黄斑变性（AMD）患者在亚型诊断上的异同。
回顾性病历审查。
我们确定了99例连续的日本渗出性AMD患眼和94例连续的法国渗出性AMD患眼的亚型诊断。第一步诊断使用FP和FA，第二步诊断使用FP、FA/ICGA和OCT。比较日本和法国医生做出的诊断，当诊断不同时，咨询第三家机构以达成最终共识和诊断。
第一步诊断与最终诊断的分歧率为20%-30%，但第二步诊断的分歧率仅为10%。息肉样脉络膜血管病变（PCV）在日本患者中（48%）比在法国患者中（9%）更常见，PCV合并1型或2型脉络膜新生血管（CNV）的比例极低：日本为3%，法国为0%。1型CNV在法国病例中显著更多（53.3%对35.1%，P=0.018），而仅2型CNV或脉络膜视网膜吻合的患眼比例在人群间相似。
多模态成像显著改善了AMD的亚分类。两个系列在1型CNV和PCV的比例上存在显著差异，而仅2型CNV和脉络膜视网膜吻合的比例在组间相似。
