Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania.
Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania.
Ophthalmology. 2018 Jul;125(7):1037-1046. doi: 10.1016/j.ophtha.2018.01.004. Epub 2018 Feb 14.
To describe risk factors for scar formation and changes to fibrotic scar through 5 years in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).
Multicenter, prospective cohort study.
A total of 1061 subjects in CATT.
Color photographic and fluorescein angiographic images from baseline and 1, 2, and 5 years were evaluated. Incidence of scar formation was estimated with Kaplan-Meier curves. Risk factors were assessed with Cox regression models.
Scar formation, fibrotic scar area, and macular atrophy associated with fibrotic scar ("atrophy").
Cumulative proportion of eyes with scar was 32%, 46%, and 56% at years 1, 2, and 5, respectively. Baseline factors associated with increased risk (adjusted hazards ratio [aHR] and 95% confidence interval [CI]) were classic choroidal neovascularization (CNV) (aHR, 4.49; 95% CI, 3.34-6.04) versus occult, hemorrhage >1 disc area (DA) (aHR, 2.28; 95% CI, 1.49-3.47) versus no hemorrhage, retinal thickness >212 μm (aHR, 2.58; 95% CI, 1.69-3.94) versus <120 μm, subretinal tissue complex thickness >275 μm (aHR, 2.64; 95% CI, 1.81-3.84) versus ≤75 μm, subretinal fluid thickness >25 μm (aHR, 1.31; 95% CI, 0.97-1.75) versus no fluid, visual acuity (VA) in fellow eye 20/20 (aHR, 1.72; 95% CI, 1.25-2.36) versus 20/50 or worse, retinal pigment epithelium elevation absence (aHR, 1.71; 95% CI, 1.21-2.41), and subretinal hyperreflective material (aHR, 1.72; 95% CI, 1.25-2.36). Among 68 eyes that developed fibrotic scar at year 1, VA decreased by a mean of additional 13 letters between years 1 and 5. Mean scar area was 1.2, 1.2, and 1.9 DA at 1, 2, and 5 years, respectively. Atrophy was present in 18%, 24%, and 54% of these eyes at years 1, 2, and 5, respectively; the mean areas were 1.6, 2.0, and 3.1 DA, respectively. Atrophy replaced fibrotic scar in 8 eyes at year 5. There was no significant correlation between scar growth and atrophy growth. The rate of growth for both was similar between the clinical trial and observation periods.
Several morphologic features, including classic CNV and large hemorrhage, are associated with scar formation. Rate of new scar formation declined after 2 years. Most fibrotic scars and accompanying macular atrophy expanded over time, reducing VA.
通过比较年龄相关性黄斑变性治疗试验（CATT）中的 5 年数据，描述瘢痕形成的风险因素和纤维化瘢痕的变化。
多中心、前瞻性队列研究。
CATT 共 1061 名受试者。
评估基线及 1、2、5 年的彩色照片和荧光素血管造影图像。采用 Kaplan-Meier 曲线估计瘢痕形成的发生率。采用 Cox 回归模型评估风险因素。
瘢痕形成、纤维化瘢痕面积以及与纤维化瘢痕相关的黄斑萎缩（“萎缩”）。
第 1、2、5 年累积出现瘢痕的眼比例分别为 32%、46%和 56%。与增加风险相关的基线因素（调整后的风险比[aHR]和 95%置信区间[CI]）为：经典脉络膜新生血管（CNV）（aHR，4.49；95%CI，3.34-6.04）比隐匿性、出血>1 个视盘面积（DA）（aHR，2.28；95%CI，1.49-3.47），视网膜厚度>212 μm（aHR，2.58；95%CI，1.69-3.94）比<120 μm，视网膜下组织复合体厚度>275 μm（aHR，2.64；95%CI，1.81-3.84）比≤75 μm，视网膜下积液厚度>25 μm（aHR，1.31；95%CI，0.97-1.75）比无积液，对侧眼视力（VA）20/20（aHR，1.72；95%CI，1.25-2.36）比 20/50 或更差，视网膜色素上皮抬高缺失（aHR，1.71；95%CI，1.21-2.41）和视网膜下高反射物质（aHR，1.72；95%CI，1.25-2.36）。在第 1 年出现纤维化瘢痕的 68 只眼中，1 年至 5 年间 VA 平均下降了 13 个字母。1、2、5 年瘢痕面积分别为 1.2、1.2 和 1.9 DA。在这些眼中，第 1、2 和 5 年分别有 18%、24%和 54%出现萎缩；平均面积分别为 1.6、2.0 和 3.1 DA。在第 5 年，有 8 只眼的瘢痕发生了萎缩。瘢痕生长和萎缩生长之间没有显著的相关性。在临床试验和观察期间，两者的生长速度相似。
几种形态特征，包括经典 CNV 和大出血，与瘢痕形成有关。新瘢痕形成的速度在 2 年后下降。大多数纤维化瘢痕和伴随的黄斑萎缩会随时间扩大，导致 VA 下降。
