Clemens Christoph R, Alten Florian, Heiduschka Peter, Eter Nicole
Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany.
Retina. 2015 Jul;35(7):1351-9. doi: 10.1097/IAE.0000000000000473.
To evaluate a morphology score for drusenoid pigment epithelial detachment (dPED) regarding predictability of a decline in retinal function beyond best-corrected visual acuity.
Thirteen eyes of 10 patients with dPED due to age-related macular degeneration (AMD) were included (age 72.8 ± 4.2 years). All underwent volume spectral domain optical coherence tomography, fluorescence angiography, and confocal scanning laser ophthalmoscopy infrared imaging as well as multifocal electroretinography and microperimetry. The dPED morphology score suggested consists of five parameters: hyperreflective spots in infrared, lesion diameter, lesion height, presence of vitelliform-like material in the subretinal space or subretinal fluid, and integrity of the ellipsoid zone in spectral domain optical coherence tomography. Subsequently, a score value between 0 and 1 according to the extent of morphologic changes was correlated to foveal multifocal electroretinography and microperimetry measurements.
The mean best-corrected visual acuity was 20/40. The mean height and mean diameter of dPED were 312.2 ± 111 μm and 2,535 ± 805 μm. Two dPED showed no hyperreflective spots in confocal scanning laser ophthalmoscopy infrared images, three displayed a moderate stage of hyperreflective spots, and eight had severe hyperreflective spots. Two eyes showed subretinal fluid, and five patients showed vitelliform-like material in the subretinal space. Eight eyes revealed a severe disruption of the ellipsoid zone. Although no correlation was found between dPED morphology score and best-corrected visual acuity, eyes with a dPED morphology score >0.5 revealed distinctly decreased values in functional measurements compared with those with a score ≤0.5.
The dPED morphology score aggregates all currently known morphologic changes in dPED and represents a valuable tool for clinical lesion evaluation. Furthermore, it allows for assessing an estimate of functional decline beyond best-corrected visual acuity.
评估玻璃膜疣样色素上皮脱离（dPED）的形态学评分，以预测视网膜功能下降程度，而不仅仅局限于最佳矫正视力。
纳入10例年龄相关性黄斑变性（AMD）所致dPED患者的13只眼（年龄72.8±4.2岁）。所有患者均接受了容积频域光学相干断层扫描、荧光血管造影、共焦扫描激光眼底镜红外成像以及多焦视网膜电图和微视野检查。所建议的dPED形态学评分由五个参数组成：红外图像中的高反射点、病变直径、病变高度、视网膜下间隙或视网膜下液中是否存在卵黄样物质以及频域光学相干断层扫描中椭圆体带的完整性。随后，根据形态学变化程度得出的0至1分的评分值与中央凹多焦视网膜电图和微视野检查测量值相关。
平均最佳矫正视力为20/40。dPED的平均高度和平均直径分别为312.2±111μm和2535±805μm。2只dPED在共焦扫描激光眼底镜红外图像中未显示高反射点，3只显示中度高反射点阶段，8只显示严重高反射点。2只眼出现视网膜下液，5例患者在视网膜下间隙出现卵黄样物质。8只眼显示椭圆体带严重破坏。虽然未发现dPED形态学评分与最佳矫正视力之间存在相关性，但与评分≤0.5的眼相比，dPED形态学评分>0.5的眼在功能测量中显示出明显降低的值。
dPED形态学评分汇总了目前已知的dPED所有形态学变化，是临床病变评估的有价值工具。此外，它还可以评估超出最佳矫正视力的功能下降估计。
