Clemens C R, Alten F, Heiduschka P, Gamulescu M A, Wolf A, Eter N
Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland.
Universitäts-Augenklinik Regensburg, Regensburg, Deutschland.
Ophthalmologe. 2018 Sep;115(9):754-760. doi: 10.1007/s00347-017-0586-8.
The ratio of choroidal neovascularization (CNV) and pigment epithelium detachment (PED) represents an important parameter regarding the risk of developing a tear of the retinal pigment epithelium (RPE) in patients with vascularized PED due to age-related macular degeneration (AMD).
Within the framework of the RECOVER study a total of 29 treatment-naive patients with vascularized PED underwent fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) volume scans. The CNV-PED ratio was evaluated retrospectively by two independent graders in three ways: 1) manually based on the en face image of the FA late phase and 2) manually based on the en face image of the ICGA late phase. 3) In every OCT scan encompassing the PED, the area between the RPE and Bruch's membrane and the CNV area was measured and multiplied by the distance between OCT scans in order to determine volumetric data of CNV, PED and the serous cavity.
The FA and ICGA showed a mean serous area of 6.14 ± 4.21 mm (ICGA 5.94 ± 4.13 mm), a mean CNV area of 3.25 ± 1.79 mm (ICGA 2.84 ± 1.68 mm) and a mean PED area of 9.39 ± 4.27 mm (ICGA 8.79 ± 4.23 mm) resulting in a mean two-dimensional morphological ratio of 0.35 ± 0.21 (ICGA 0.32 ± 0.22). The volumetric measurement revealed a mean CNV volume of 0.63 ± 0.67 mm, a mean serous volume of 3.61 ± 3.83 mm and a mean total PED volume of 4.25 ± 3.68 mm. The mean three-dimensional morphological ratio was 0.15 ± 0.29. The difference between the two-dimensional ratios of FA (p < 0.0001) and ICGA (p = 0.0004) was significant compared to the three-dimensional OCT ratio.
Assessment of the CNV-PED ratio using volumetric OCT measurements is an additional tool to the en face modalities FA and ICGA. This seems to be clinically relevant regarding the risk stratification of RPE tear development in PED patients and for the planning of the treatment regimen.
脉络膜新生血管（CNV）与色素上皮脱离（PED）的比例是评估年龄相关性黄斑变性（AMD）所致血管化PED患者发生视网膜色素上皮（RPE）撕裂风险的一个重要参数。
在RECOVER研究框架内，共有29例初治的血管化PED患者接受了荧光素血管造影（FA）、吲哚菁绿血管造影（ICGA）和光学相干断层扫描（OCT）容积扫描。两名独立的分级人员采用三种方法对CNV-PED比例进行回顾性评估：1）基于FA晚期的正面图像手动评估；2）基于ICGA晚期的正面图像手动评估；3）在包含PED的每次OCT扫描中，测量RPE与 Bruch膜之间的区域以及CNV区域，并乘以OCT扫描之间的距离，以确定CNV、PED和浆液腔的容积数据。
FA和ICGA显示，浆液平均面积为6.14±4.21mm（ICGA为5.94±4.13mm），CNV平均面积为3.25±1.79mm（ICGA为2.84±1.68mm），PED平均面积为9.39±4.27mm（ICGA为8.79±4.23mm），二维形态学平均比例为0.35±0.21（ICGA为0.32±0.22）。容积测量显示，CNV平均容积为0.63±0.67mm，浆液平均容积为3.61±3.83mm，PED总平均容积为4.25±3.68mm。三维形态学平均比例为0.15±0.29。与三维OCT比例相比，FA（p<0.0001）和ICGA（p = 0.0004）的二维比例差异具有显著性。
使用容积OCT测量评估CNV-PED比例是FA和ICGA等正面成像方式之外的一种辅助工具。这在PED患者RPE撕裂发生风险分层及治疗方案规划方面似乎具有临床相关性。
