Casalino Giuseppe, Bandello Francesco, Chakravarthy Usha
Ophthalmology Macular Service Belfast Health and Social Care Trust and Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom 2Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, It.
Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy.
Invest Ophthalmol Vis Sci. 2016 Jul 1;57(9):OCT288-98. doi: 10.1167/iovs.15-18753.
To correlate presence of hyperreflective material (HRM) on spectral-domain optical coherence tomography (SD-OCT) with color fundus photography (CFP) in patients with different subtypes of neovascular age-related macular degeneration (n-AMD).
Retrospective assessments were made at baseline and months 1, 3, and 12 after initiation of treatment. At baseline, CFP images were graded for the presence of blood, fibrin and lipid exudates, and retinal angiograms for n-AMD subtype. At the four selected visits, SD-OCT scans were graded for HRM type (well-defined or undefined) and location (subretinal, intraretinal, and subretinal pigment epithelium [RPE]), integrity of RPE, ellipsoid zone, and external limiting membrane (ELM).
A total of 121 eyes with active n-AMD from 117 patients were included. At baseline, undefined HRM was strongly associated with fibrin on CFP (χ2 = 39.87; P < 0.001). The overall prevalence of HRM decreased from 85.9% at baseline to 52.9% by month 12. From baseline to month 12, undefined HRM decreased (53.7% vs. 7.4%, respectively) and well-defined HRM increased (32.2% vs. 45.5%, respectively). Sub-RPE HRM, which was infrequent at baseline, increased up to 30.6% by month 12. At month 12, eyes with no HRM had the best mean final best-corrected visual acuity (BCVA), and those with undefined HRM the worst. Multivariate regression analysis showed that ELM disruption at both baseline and month 12 was a negative predictive factor for final BCVA (P = 0.001 and P < 0.001, respectively), whereas presence of subretinal fluid at month 12 and number of treatments were positive predictors for final BCVA (P = 0.007 and P = 0.041, respectively), but the covariates describing HRM did not reach statistical significance in these models.
In eyes with n-AMD, location and morphology of HRM changed after anti-VEGF treatment, and differences were observed in the various choroidal neovascularization (CNV) subtypes. After anti-VEGF treatment, it was well-defined HRM in the sub-RPE space that was observed mostly.
在不同亚型的新生血管性年龄相关性黄斑变性（n-AMD）患者中，将光谱域光学相干断层扫描（SD-OCT）上高反射物质（HRM）的存在情况与彩色眼底照相（CFP）进行关联分析。
在治疗开始时的基线以及第1、3和12个月进行回顾性评估。在基线时，对CFP图像进行血液、纤维蛋白和脂质渗出物的分级，并对n-AMD亚型进行视网膜血管造影。在四个选定的访视点，对SD-OCT扫描进行HRM类型（明确或不明确）和位置（视网膜下、视网膜内以及视网膜色素上皮[RPE]下）、RPE完整性、椭圆体带和外界膜（ELM）的分级。
共纳入117例患者的121只患有活动性n-AMD的眼睛。在基线时，不明确的HRM与CFP上的纤维蛋白密切相关（χ2 = 39.87；P < 0.001）。HRM的总体患病率从基线时的85.9%下降到第12个月时的52.9%。从基线到第12个月，不明确的HRM减少（分别为53.7%和7.4%），明确的HRM增加（分别为32.2%和45.5%）。RPE下HRM在基线时较少见，到第12个月时增加到30.6%。在第12个月时，没有HRM的眼睛最终最佳矫正视力（BCVA）均值最佳，而有不明确HRM的眼睛最差。多因素回归分析显示，基线和第12个月时的ELM破坏是最终BCVA的负性预测因素（分别为P = 0.001和P < 0.001），而第12个月时视网膜下液的存在和治疗次数是最终BCVA的正性预测因素（分别为P = 0.007和P = 0.041），但在这些模型中描述HRM的协变量未达到统计学意义。
在n-AMD患者的眼睛中，抗VEGF治疗后HRM的位置和形态发生了变化，并且在不同的脉络膜新生血管（CNV）亚型中观察到了差异。抗VEGF治疗后，大多观察到的是RPE下明确的HRM。
