Zhou Qiang, Daniel Ebenezer, Maguire Maureen G, Grunwald Juan E, Martin E Revell, Martin Daniel F, Ying Gui-Shuang
Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Ophthalmology. 2016 Jul;123(7):1530-40. doi: 10.1016/j.ophtha.2016.02.043. Epub 2016 Apr 1.
To evaluate the association between pseudodrusen and incidence of late age-related macular degeneration (AMD) in fellow eyes of patients with unilateral neovascular AMD (nAMD).
Cohort study within the Comparison of AMD Treatments Trials (CATT).
Patients with neither nAMD nor geographic atrophy (GA) in the fellow eye at baseline.
Presence and type (dot, reticular, or confluent) of baseline pseudodrusen were assessed using digital color fundus photography (CFP) viewed under full color, green channel, and blue channel; red-free images; and fluorescein angiography (FA). Incidence of nAMD was based on monthly clinical examination and reading center evaluation of images at years 1 and 2. Incidence of GA was based on reading center evaluation of CFP and FA images at years 1 and 2. Associations of baseline pseudodrusen with incident nAMD and GA were summarized with adjusted risk ratios (aRRs) and their 95% confidence intervals (CIs) from multivariate Cox models, with adjustment of covariates identified through backward stepwise selection.
Incident nAMD and GA.
Among 620 fellow eyes, 176 (28.4%) had baseline pseudodrusen (55% dot, 82% reticular, 35% confluent). Within 2 years, nAMD occurred in 54 eyes (30.7%) with pseudodrusen and in 72 eyes (16.2%) without pseudodrusen (aRR, 2.05; 95% CI, 1.43-2.93); GA occurred in 27 eyes (15.3%) with pseudodrusen and in 37 eyes (8.3%) without pseudodrusen (aRR, 1.89; 95% CI, 1.13-3.17); late AMD occurred in 73 eyes (41.5%) with pseudodrusen and in 101 eyes (22.8%) without pseudodrusen (aRR, 2.07; 95% CI, 1.51-2.83). Dot pseudodrusen were associated independently with nAMD (aRR, 2.53; 95% CI, 1.60-4.00), whereas confluent pseudodrusen were associated independently with GA (aRR, 4.35; 95% CI, 1.69-11.2). Eyes with pseudodrusen had increased incidence of late AMD regardless of whether the Age-Related Eye Diseases Study (AREDS) severity score was 2 (28.7% vs. 10.3%), 3 (34.9% vs. 13.7%), or 4 (50.5% vs. 32.0%).
In fellow eyes of CATT participants, pseudodrusen were associated independently with a higher incidence of both nAMD and GA. Dot pseudodrusen were associated with nAMD, whereas confluent pseudodrusen were associated with GA. Pseudodrusen should be considered along with the AREDS severity score for predicting late AMD.
评估单侧新生血管性年龄相关性黄斑变性（nAMD）患者对侧眼中假性玻璃膜疣与晚期年龄相关性黄斑变性（AMD）发病率之间的关联。
年龄相关性黄斑变性治疗试验（CATT）中的队列研究。
基线时对侧眼既无nAMD也无地图样萎缩（GA）的患者。
使用全彩色、绿色通道和蓝色通道下观察的数字彩色眼底照相（CFP）、无赤光图像和荧光素血管造影（FA）评估基线假性玻璃膜疣的存在情况和类型（点状、网状或融合状）。nAMD的发病率基于第1年和第2年的每月临床检查以及图像阅读中心评估。GA的发病率基于第1年和第2年阅读中心对CFP和FA图像的评估。通过多变量Cox模型，采用经向后逐步选择确定的协变量调整，汇总基线假性玻璃膜疣与nAMD和GA发病的关联，并计算调整风险比（aRRs）及其95%置信区间（CIs）。
nAMD和GA发病情况。
在620只对侧眼中，176只（28.4%）有基线假性玻璃膜疣（55%为点状，82%为网状，35%为融合状）。在2年内，有假性玻璃膜疣的眼中54只（30.7%）发生了nAMD，无假性玻璃膜疣的眼中72只（16.2%）发生了nAMD（aRR，2.05；95%CI，1.43 - 2.93）；有假性玻璃膜疣的眼中27只（15.3%）发生了GA，无假性玻璃膜疣的眼中37只（8.3%）发生了GA（aRR，1.89；95%CI，1.13 - 3.17）；晚期AMD在有假性玻璃膜疣的眼中73只（41.5%）发生，在无假性玻璃膜疣的眼中101只（22.8%）发生（aRR，2.07；95%CI，1.51 - 2.83）。点状假性玻璃膜疣独立与nAMD相关（aRR，2.53；95%CI，1.60 - 4.00），而融合状假性玻璃膜疣独立与GA相关（aRR，4.35；95%CI，1.69 - 11.2）。无论年龄相关性眼病研究（AREDS）严重程度评分是2（28.7%对10.3%）、3（34.9%对13.7%）还是4（50.5%对32.0%），有假性玻璃膜疣的眼晚期AMD发病率均升高。
在CATT参与者的对侧眼中，假性玻璃膜疣独立与nAMD和GA的较高发病率相关。点状假性玻璃膜疣与nAMD相关，而融合状假性玻璃膜疣与GA相关。在预测晚期AMD时，应将假性玻璃膜疣与AREDS严重程度评分一并考虑。
