2型特发性黄斑毛细血管扩张症的睫状神经营养因子一期试验中结构与功能预后指标的相关性
CORRELATION OF STRUCTURAL AND FUNCTIONAL OUTCOME MEASURES IN A PHASE ONE TRIAL OF CILIARY NEUROTROPHIC FACTOR IN TYPE 2 IDIOPATHIC MACULAR TELANGIECTASIA.
作者信息
Sallo Ferenc B, Leung Irene, Clemons Traci E, Peto Tunde, Chew Emily Y, Pauleikhoff Daniel, Bird Alan C
机构信息
Department of Research and Development, Moorfields Eye Hospital, London, United Kingdom.
UCL Institute of Ophthalmology, London, United Kingdom.
出版信息
Retina. 2018 Jan;38 Suppl 1(Suppl 1):S27-S32. doi: 10.1097/IAE.0000000000001706.
PURPOSE
Macular telangiectasia Type 2 is a bilateral, progressive, potentially blinding retinal disease characterized by both vascular and neurodegenerative signs. Both the area of the break in the ellipsoid zone seen in "en face" optical coherence tomographic (OCT) images and microperimetric focal retinal sensitivity loss have been proposed as potential measures of progression in macular telangiectasia. The authors aimed to assess the characteristics and interrelationship of these structural and functional disease markers from the data collected in a phase one clinical trial of ciliary neurotrophic factor in macular telangiectasia.
METHODS
Orthogonal topographic (en face) maps of the ellipsoid zone were generated from Heidelberg Spectralis OCT volume scans (15 × 10° area, 30-μm B-scan intervals) or Zeiss Cirrus HD-OCT 4000 512 × 128 cube scans. Mesopic microperimetry was performed on CenterVue MAIA perimeters, using a Goldmann III stimulus in a custom test grid. Structural and functional data were analyzed by two methods: by calculating aggregate loss and by simple thresholding. The alignment quality of structural and functional data was also evaluated.
RESULTS
Overall, the break area showed a good correlation with aggregate sensitivity loss (ρ = 0.834, P < 0.0001, 95% confidence interval 0.716-0.906) but also with the number of test points below a threshold value (e.g., <20 dB: ρ = 0.843, P < 0.0001, 95% confidence interval 0.755-0.902). Significant misalignment of the MAIA test grid was apparent in 13/48 visits of 7/14 eyes.
CONCLUSION
The authors found a good correlation between ellipsoid zone break area and function loss. En face OCT mapping of the ellipsoid zone appears to demonstrate structural change before mesopic microperimetry can detect a focal loss of retinal sensitivity. Thresholding offers a quick alternative to calculating aggregate sensitivity loss.
目的
2型黄斑毛细血管扩张症是一种双侧性、进行性、可能致盲的视网膜疾病，其特征为血管和神经退行性病变体征。“正面”光学相干断层扫描（OCT）图像中椭圆体带破裂区域以及微视野视网膜局灶性敏感性丧失均被认为是黄斑毛细血管扩张症病情进展的潜在指标。作者旨在根据在一项关于睫状神经营养因子治疗黄斑毛细血管扩张症的一期临床试验中收集的数据，评估这些结构和功能疾病标志物的特征及相互关系。
方法
椭圆体带的正交地形图（正面图）由海德堡Spectralis OCT容积扫描（15×10°区域，30μm B扫描间隔）或蔡司Cirrus HD - OCT 4000 512×128立方扫描生成。在CenterVue MAIA视野计上进行中视微视野检查，在定制测试网格中使用Goldmann III刺激。通过两种方法分析结构和功能数据：计算总损失和简单阈值化。还评估了结构和功能数据的对齐质量。
结果
总体而言，破裂区域与总敏感性损失显示出良好的相关性（ρ = 0.834，P < 0.0001，95%置信区间0.716 - 0.906），但也与低于阈值（例如，<20 dB）的测试点数相关（ρ = 0.843，P < 0.0001，95%置信区间0.755 - 0.902）。在14只眼中的7只眼的48次就诊中有13次出现MAIA测试网格明显的显著未对齐。
结论
作者发现椭圆体带破裂区域与功能丧失之间存在良好的相关性。在中视微视野检查能够检测到视网膜敏感性局灶性丧失之前，椭圆体带的正面OCT映射似乎就已显示出结构变化。阈值化提供了一种计算总敏感性损失的快速替代方法。
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