Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy.
Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy.
Retina. 2018 May;38(5):1041-1046. doi: 10.1097/IAE.0000000000001634.
To provide a systematic classification of findings regarding the different stages of vitelliform macular dystrophy on spectral domain optical coherence tomography (SD-OCT).
Ninety-four eyes of 47 patients were recruited in a prospective cross-sectional study. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity using Early Treatment Diabetic Retinopathy Study (ETDRS) charts, biomicroscopy, and SD-OCT. The findings assessed included vitelliform material, neurosensory detachment, status of external limiting membrane, ellipsoid zone and retinal pigment epithelium, choroidal excavation, foveal cavitation, choroidal neovascularization, vitreomacular traction, and macular hole. The primary outcome measure was the identification of SD-OCT findings in each vitelliform macular dystrophy stage. Secondary outcomes included the correlations between SD-OCT features and visual acuity changes.
The outer retinal layers (external limiting membrane, ellipsoid zone, and retinal pigment epithelium) were found to be more commonly disrupted in Stages 2 to 4 (range: 86%-100%), whereas their absence was more typical of Stage 5 (71%-86%). Vitelliform material was found in 100% of Stages 2 and 3, 93% of Stage 4, and interestingly in 43% of Stage 5. Eyes characterized by vitelliform material showed a greater correlation with higher best-corrected visual acuity than eyes without it (0.35 logarithm of the minimum angle of resolution vs. 0.80 ± 0.36 logarithm of the minimum angle of resolution, approximately 20/45 and 20/125 Snellen equivalent, respectively) (t = 3.726, P < 0.05). Moreover, its absence was associated with a best-corrected visual acuity of 0.5 logarithm of the minimum angle of resolution or worse (approximately 20/63 Snellen equivalent; P < 0.05). Subretinal fluid was more common in Stages 3 and 4 (72.7% and 75%, respectively) than Stages 2 and 5 (P = 0.004). Eyes with subretinal fluid were significantly associated with a visual acuity of 0.2 logarithm of the minimum angle of resolution or worse (approximately 20/32 Snellen equivalent; P = 0.04).
Spectral domain optical coherence tomography assessment primarily indicates an outer retinal layer disruption in Stages 2 to 4, along with the presence of vitelliform material extending into the more advanced clinical stages too. Eyes characterized by the persistence of vitelliform material show better best-corrected visual acuity. Future investigations based on a longitudinal follow-up are warranted to correlate SD-OCT modifications with functional responses to identify SD-OCT indicators for prognostic and therapeutic purposes.
提供一个关于玻璃膜疣性黄斑营养不良不同阶段的谱域光相干断层扫描（SD-OCT）检查结果的系统分类。
本前瞻性横断面研究共纳入 47 例（94 只眼）患者。所有患者均接受全面眼科检查，包括使用早期糖尿病视网膜病变研究（ETDRS）图表进行最佳矫正视力检查、生物显微镜检查和 SD-OCT 检查。评估的发现包括玻璃膜疣物质、神经感觉脱离、外部限制膜状态、椭圆体带和视网膜色素上皮、脉络膜凹陷、黄斑中心凹空洞、脉络膜新生血管、玻璃体细胞牵引和黄斑裂孔。主要观察指标是确定每个玻璃膜疣性黄斑营养不良阶段的 SD-OCT 检查结果。次要观察指标包括 SD-OCT 特征与视力变化的相关性。
在外视网膜层（外部限制膜、椭圆体带和视网膜色素上皮）中，在 2 至 4 期（范围：86%-100%）中发现更常见的破坏，而在 5 期（71%-86%）中则更典型地发现其缺失。在 2 期和 3 期，100%的眼中存在玻璃膜疣物质，在 4 期为 93%，在有趣的是在 5 期为 43%。具有玻璃膜疣物质的眼睛与更高的最佳矫正视力之间的相关性大于没有玻璃膜疣物质的眼睛（0.35 对数最小分辨角 vs. 0.80 ± 0.36 对数最小分辨角，约为 20/45 和 20/125 Snellen 等效视力）（t = 3.726，P < 0.05）。此外，其缺失与最佳矫正视力为 0.5 对数最小分辨角或更差（约为 20/63 Snellen 等效视力；P < 0.05）相关。在 3 期和 4 期（分别为 72.7%和 75%）中，比在 2 期和 5 期（P = 0.004）中更常见的是视网膜下液。存在视网膜下液的眼睛与视力为 0.2 对数最小分辨角或更差（约为 20/32 Snellen 等效视力；P = 0.04）显著相关。
SD-OCT 评估主要表明在 2 至 4 期存在外视网膜层破坏，并且在更高级的临床阶段也存在玻璃膜疣物质延伸。具有玻璃膜疣物质持续存在的眼睛表现出更好的最佳矫正视力。基于纵向随访的未来研究需要将 SD-OCT 改变与功能反应相关联，以确定 SD-OCT 指标用于预后和治疗目的。
