Moreira-Neto Carlos A, Moult Eric M, Fujimoto James G, Waheed Nadia K, Ferrara Daniela
Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA.
Hospital de Olhos do Paraná, Curitiba, PR, Brazil.
J Ophthalmol. 2018 Jan 30;2018:8125267. doi: 10.1155/2018/8125267. eCollection 2018.
The purpose of this review is to summarize the current knowledge on choriocapillaris loss in advanced age macular degeneration (AMD). Several histopathological studies in animal models and human eyes had showed that the choriocapillaris density decreases with age. However, the role of choriocapillaris loss is still unclear in AMD and its advanced forms, either choroidal neovascularization (CNV) or geographic atrophy (GA). Some authors have hypothesized that choriocapillaris loss might precede overt retinal pigment epithelium atrophy. Others have hypothesized that deposition of complement complexes on and around the choriocapillaris could be related to the tissue loss observed in early AMD. The development of imaging modalities, such as optical coherence tomography angiography (OCTA), have led to a better understanding of underlying physiopathological mechanisms in AMD. OCTA showed atrophy of choriocapillaris underneath and beyond the region of photoreceptors and RPE loss, in agreement with previous histopathologic studies. The evolution of OCTA technology suggests that CNV seems to originate from regions of severe choriocapillaris alteration. Significant progress has been made in the understanding of development and progression of GA and CNV. investigation of the choriocapillaris using OCTA may lead to new insights related to underlying disease mechanisms in AMD.
本综述的目的是总结关于年龄相关性黄斑变性（AMD）中脉络膜毛细血管丧失的现有知识。在动物模型和人眼中进行的多项组织病理学研究表明，脉络膜毛细血管密度随年龄增长而降低。然而，在AMD及其晚期形式，即脉络膜新生血管（CNV）或地图样萎缩（GA）中，脉络膜毛细血管丧失的作用仍不清楚。一些作者推测，脉络膜毛细血管丧失可能先于明显的视网膜色素上皮萎缩。另一些人则推测，脉络膜毛细血管上及其周围补体复合物的沉积可能与早期AMD中观察到的组织丧失有关。成像技术的发展，如光学相干断层扫描血管造影（OCTA），使人们对AMD潜在的生理病理机制有了更好的理解。OCTA显示，在光感受器区域下方和之外的脉络膜毛细血管萎缩以及视网膜色素上皮丧失，这与先前的组织病理学研究一致。OCTA技术的发展表明，CNV似乎起源于脉络膜毛细血管严重改变的区域。在理解GA和CNV的发生和发展方面已经取得了重大进展。使用OCTA对脉络膜毛细血管进行研究可能会为AMD潜在的疾病机制带来新的见解。
