Zhao Jie, Hu Jun, Lu Hao, Yang Lei
Department of Ophthalmology, Baoshan Central Hospital, Shanghai 201906, P.R. China.
Exp Ther Med. 2014 Aug;8(2):371-376. doi: 10.3892/etm.2014.1731. Epub 2014 May 26.
The aim of the present study was to investigate the pathomorphological and functional variations of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) in a Chinese population using optical coherence tomography (OCT). This population-based study enrolled 59 patients (age, >45 years; eyes, 70) with early and intermediate-stage AMD from Youyi Road Community, Baoshan District, Shanghai, China. Comprehensive standardized ophthalmic examinations included visual acuity, anterior segment analysis using a slit lamp, dilated fundus evaluation by direct ophthalmoscopy, 90D handheld lens analysis, fundus photography, fundus fluorescein angiography (FFA) and fast optic disk scans using OCT. The macular CNV characteristic profiles in early and intermediate-stage AMD were determined by OCT. Data were obtained on the first visit and the follow-up period ranged between 6 and 24 months, where FFA and OCT outcomes of early and intermediate-stage AMD patients were analyzed. Three profiles of early and intermediate-stage AMD were created from the OCT and FFA results, each with a different prognosis. Firstly, drusens with unclear boundaries and evident pigment proliferation, as well as hypofluorescence around the drusens, was observed via FFA. A slight small arch field located in the retinal pigment epithelium (RPE)/choriocapillary layer (CCL) was shown on OCT scans, indicating exudative AMD. Secondly, RPE detachments of >1 pupillary distance, without CNV in the macular area, indicated geographic chorioretinitis atrophy. Finally, drusens with clear boundaries and few pigment proliferations and no certain surrounding fluorescence was observed via FFA, while a clear RPE/CCL band on the OCT scans indicated slow progress. The results of the present study demonstrated that combined OCT and FFA was the most efficient method for identifying CNV and diagnosing AMD. If the two techniques are not available concurrently, then OCT is a safer and more reliable technique to follow-up early and intermediate-stage AMD patients.
本研究的目的是利用光学相干断层扫描（OCT）研究中国人群年龄相关性黄斑变性（AMD）中脉络膜新生血管（CNV）的病理形态学和功能变化。这项基于人群的研究纳入了来自中国上海宝山区友谊路社区的59例年龄大于45岁的早中期AMD患者（共70只眼）。全面的标准化眼科检查包括视力、使用裂隙灯进行眼前节分析、直接检眼镜进行散瞳眼底评估、90D手持透镜分析、眼底照相、眼底荧光血管造影（FFA）以及使用OCT进行快速视盘扫描。通过OCT确定早中期AMD黄斑CNV的特征性表现。在首次就诊时获取数据，随访期为6至24个月，分析早中期AMD患者的FFA和OCT结果。根据OCT和FFA结果创建了早中期AMD的三种表现类型，每种类型预后不同。首先，通过FFA观察到边界不清且色素增殖明显的玻璃膜疣，以及玻璃膜疣周围的低荧光。OCT扫描显示视网膜色素上皮（RPE）/脉络膜毛细血管层（CCL）有轻微的小弧形区域，提示渗出性AMD。其次，RPE脱离大于1个瞳孔距离，黄斑区无CNV，提示地图状脉络膜视网膜萎缩。最后，通过FFA观察到边界清晰、色素增殖少且周围无特定荧光的玻璃膜疣，而OCT扫描显示清晰的RPE/CCL带提示进展缓慢。本研究结果表明，联合使用OCT和FFA是识别CNV和诊断AMD的最有效方法。如果这两种技术不能同时使用，那么OCT是随访早中期AMD患者更安全、更可靠的技术。
