Su Daniel, Lin Shawn, Phasukkijwatana Nopasak, Chen Xuejing, Tan Anna, Freund K Bailey, Sarraf David
*Stein Eye Institute, University of California Los Angeles, Los Angeles, California; †Singapore Eye Center and Singapore Eye Research Institute, Singapore; ‡Vitreous Retina Macula Consultants of New York, New York, New York; §LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; ¶Department of Ophthalmology, New York University School of Medicine, New York, New York; **Greater Los Angeles Veteran's Administration Healthcare Center, Los Angeles, California; and ††Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California.
Retina. 2016 Dec;36 Suppl 1:S40-S49. doi: 10.1097/IAE.0000000000001268.
To comprehensively investigate spectral domain optical coherence tomography features associated with Type 3 neovascularization and determine the prevalence of each feature and to develop an updated staging system for Type 3 neovascularization based on spectral domain optical coherence tomography findings.
The authors retrospectively analyzed 34 eyes with new-onset Type 3 neovascularization. Spectral domain optical coherence tomography images at onset of Type 3 neovascularization, immediately after the first injection, and at the final quiescent visit were analyzed for the presence of specific optical coherence tomography features. In addition, when available, optical coherence tomography images from the visit before onset were studied.
Among 18 eyes with preonset optical coherence tomography, 77.8% had preexisting intraretinal hyperreflective foci (precursor lesion). In the same group of eyes, 44.4% and 27.8% exhibited outer plexiform layer disruption and outer plexiform layer downward deflection, respectively. At the onset of detectable Type 3 neovascularization, all 34 eyes demonstrated a hyperreflective focus with cystoid macular edema and 85.3% exhibited disruption of the retinal pigment epithelium. Serous pigment epithelial detachment and subretinal fluid were present in 67.6% and 23.5% of eyes at onset, respectively. The rate of cystoid macular edema decreased from 100% to 17.6% after a single injection. At the final quiescent visit, focal atrophy at the site of Type 3 lesions, as evidenced by outer retinal and retinal pigment epithelium disruption developed in 88.2% and 52.9% of eyes, respectively.
An updated staging system of Type 3 lesions was developed based on spectral domain optical coherence tomography findings. A precursor stage consists of a punctate hyperreflective focus in the outer retina. The subtle detection of associated outer plexiform layer disruption and downward deflection may indicate that this precursor lesion is more likely to progress to an active Type 3 neovascular lesion. Stage 1 consists of a larger intraretinal hyperreflective lesion associated with cystoid macular edema but without outer retinal disruption. Stage 2 is notable for outer retinal disruption that occurs with retinal pigment epithelium disruption in most of the cases. Stage 3 is defined by an intraretinal hyperreflective lesion that extends through the retinal pigment epithelium to vascularize a drusenoid pigment epithelial detachment creating a serous component of the pigment epithelial detachment.
全面研究与3型新生血管相关的频域光学相干断层扫描特征，确定每种特征的发生率，并基于频域光学相干断层扫描结果开发更新的3型新生血管分期系统。
作者回顾性分析了34只新发3型新生血管的眼睛。分析3型新生血管发病时、首次注射后即刻以及最后静止期的频域光学相干断层扫描图像，以确定是否存在特定的光学相干断层扫描特征。此外，如有发病前的光学相干断层扫描图像，也进行研究。
在18只发病前有光学相干断层扫描图像的眼睛中，77.8%有视网膜内高反射灶（前驱病变）。在同一组眼睛中，分别有44.4%和27.8%表现出外丛状层破坏和外丛状层向下偏移。在可检测到3型新生血管发病时，所有34只眼睛均显示有高反射灶伴黄斑囊样水肿，85.3%表现出视网膜色素上皮破坏。发病时，浆液性色素上皮脱离和视网膜下液分别出现在67.6%和23.5%的眼睛中。单次注射后，黄斑囊样水肿的发生率从100%降至17.6%。在最后静止期，3型病变部位出现局灶性萎缩，分别有88.2%和52.9%的眼睛出现外层视网膜和视网膜色素上皮破坏。
基于频域光学相干断层扫描结果开发了更新的3型病变分期系统。前驱期由外层视网膜的点状高反射灶组成。相关外丛状层破坏和向下偏移的细微检测可能表明该前驱病变更有可能进展为活动性3型新生血管病变。1期由与黄斑囊样水肿相关但无外层视网膜破坏的较大视网膜内高反射病变组成。大部分病例中，2期以外层视网膜破坏伴视网膜色素上皮破坏为显著特征。3期定义为视网膜内高反射病变穿过视网膜色素上皮，使类玻璃膜疣样色素上皮脱离血管化，形成色素上皮脱离的浆液成分。
