Zanzottera Emma C, Ach Thomas, Huisingh Carrie, Messinger Jeffrey D, Freund K Bailey, Curcio Christine A
*Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama; †Department of Clinical Science ''Luigi Sacco,'' Eye Clinic, Sacco Hospital, University of Milan, Milan, Italy; ‡Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany; §Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; ¶Vitreous Retina Macula Consultants of New York, New York, New York; and **Department of Ophthalmology, New York University School of Medicine, New York, New York.
Retina. 2016 Dec;36 Suppl 1(Suppl 1):S26-S39. doi: 10.1097/IAE.0000000000001330.
To enable future studies of retinal pigment epithelium (RPE) fate in the macular atrophy occurring in eyes with neovascular age-related macular degeneration (nvAMD), the authors determined how RPE morphology changes across the transition from health to atrophy in donor eyes with nvAMD.
In RPE-Bruch membrane flat mounts of 5 nvAMD eyes, the terminations of organized RPE cytoskeleton and autofluorescent material were compared. In high-resolution histologic sections of 27 nvAMD eyes, RPE phenotypes were assessed at ±500 μm and ±100 μm from the descent of the external limiting membrane (ELM) toward the Bruch membrane. Thicknesses of RPE, basal laminar deposit (BLamD), and RPE + BLamD were determined. Shapes of the ELM descent were recorded.
Approaching the ELM descent, the percentage of different RPE phenotypes and the thickness of RPE, BLamD, and RPE + BLamD each stayed roughly constant. Compared with a separately described cohort of eyes with geographic atrophy, eyes with nvAMD were more likely to have RPE dysmorphia that did not worsen toward the atrophy border, thinner BLamD overall (3.25 ± 3.46 μm vs. 7.99 ± 7.49 μm for geographic atrophy), and a higher proportion of oblique ELM descents (47.9 vs. 31.9%).
The distribution of RPE phenotypes at the transition to macular atrophy in eyes with nvAMD differs from that in primary geographic atrophy, likely reflecting greater photoreceptor loss and the effects of exudation in nvAMD. This distribution, the shape of ELM descents, and thickness profiles may be useful metrics in clinical studies of macular atrophy using optical coherence tomography and fundus autofluorescence.
为了能够在新生血管性年龄相关性黄斑变性（nvAMD）患者眼睛发生的黄斑萎缩中对视网膜色素上皮（RPE）命运进行未来研究，作者确定了在患有nvAMD的供体眼中，RPE形态在从健康到萎缩的转变过程中是如何变化的。
在5只nvAMD眼睛的RPE-布鲁赫膜平铺标本中，比较了有组织的RPE细胞骨架和自发荧光物质的末端。在27只nvAMD眼睛的高分辨率组织学切片中，在距外界膜（ELM）向布鲁赫膜下降处±500μm和±100μm处评估RPE表型。测定RPE、基底膜沉积物（BLamD）和RPE+BLamD的厚度。记录ELM下降的形状。
接近ELM下降处时，不同RPE表型的百分比以及RPE、BLamD和RPE+BLamD的厚度各自大致保持恒定。与单独描述的地图样萎缩眼睛队列相比，nvAMD眼睛更有可能出现不向萎缩边界恶化的RPE畸形，总体上BLamD更薄（地图样萎缩为7.99±7.49μm，nvAMD为3.25±3.46μm），并且ELM倾斜下降的比例更高（47.9%对31.9%）。
nvAMD患者眼睛向黄斑萎缩转变时RPE表型的分布与原发性地图样萎缩不同，这可能反映了nvAMD中更大程度的光感受器丧失和渗出的影响。这种分布、ELM下降的形状和厚度特征可能是使用光学相干断层扫描和眼底自发荧光进行黄斑萎缩临床研究中的有用指标。
