Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy.
Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy.
Am J Ophthalmol. 2018 Mar;187:61-70. doi: 10.1016/j.ajo.2017.12.013. Epub 2017 Dec 27.
To evaluate vascular abnormalities at superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC) in patients with Best vitelliform macular dystrophy (BVMD) by means of optical coherence tomography angiography (OCT-A).
Cross-sectional case series.
Sixty-six eyes of 33 patients with BVMD (16 male) and 33 controls were consecutively enrolled. Patients were subdivided into classic stages and underwent best-corrected visual acuity (BCVA), fundus autofluorescence and spectral domain-optical coherence tomography, and 4.5 × 4.5-mm swept-source OCT-A. Choroidal neovascularization (CNV) and capillary dilations were qualitatively assessed by 2 masked ophthalmologists. Each OCT-A slab was imported into ImageJ 1.50 and digitally binarized for quantitative analyses. Foveal avascular zone (FAZ) area was measured manually; vessel density was then quantified after the exclusion of the FAZ pixels. Eyes classified as stages 3 and 4 were evaluated together.
Nineteen eyes (28.8%) revealed capillary dilations at DCP, 15 of which were in stages 1 and 2. Interestingly, CNV was detected in 24 eyes (36.4%). Quantitative analysis disclosed that stages 3-4 and 5 carry significant impairment at both SCP (P < .0001 and P = .02, respectively) and DCP (P < .0001 and P = .0004, respectively) compared to controls. FAZ area was enlarged at the DCP (P = .001). Only DCP vessel density significantly correlated with the stage and BCVA.
Patients with BVMD show significant vascular impairment at both superficial and deep retinal plexuses, correlating with functional outcomes. These findings, especially at DCP, may improve our understanding about the pathogenesis, and may help in predicting BVMD treatment efficacy.
通过光学相干断层扫描血管造影术（OCT-A）评估患有 Best 型卵黄样黄斑营养不良（BVMD）患者的浅层（SCP）和深层（DCP）毛细血管丛和脉络膜毛细血管（CC）的血管异常。
横断面病例系列。
连续纳入 33 名 BVMD 患者（16 名男性）的 66 只眼和 33 名对照者。患者分为经典期，并接受最佳矫正视力（BCVA）、眼底自发荧光和谱域光相干断层扫描，以及 4.5×4.5mm 扫频源 OCT-A 检查。两名盲法眼科医生对脉络膜新生血管（CNV）和毛细血管扩张进行定性评估。将每个 OCT-A 切片导入 ImageJ 1.50 并进行数字二值化进行定量分析。手动测量中心凹无血管区（FAZ）面积；然后排除 FAZ 像素后，量化血管密度。将分类为 3 期和 4 期的眼进行联合评估。
19 只眼（28.8%）在 DCP 出现毛细血管扩张，其中 15 只眼处于 1 期和 2 期。有趣的是，24 只眼（36.4%）检测到 CNV。定量分析显示，3-4 期和 5 期与对照组相比，在 SCP（P<0.0001 和 P=0.02）和 DCP（P<0.0001 和 P=0.0004）均有显著损伤。DCP 的 FAZ 面积增大（P=0.001）。只有 DCP 血管密度与分期和 BCVA 显著相关。
BVMD 患者在浅层和深层视网膜丛均表现出明显的血管损伤，与功能结果相关。这些发现，特别是在 DCP，可能有助于我们更好地了解发病机制，并可能有助于预测 BVMD 治疗效果。
