伴有 3 型新生血管和年龄相关性黄斑变性的眼脉络膜血流减少。
REDUCED CHORIOCAPILLARIS FLOW IN EYES WITH TYPE 3 NEOVASCULARIZATION AND AGE-RELATED MACULAR DEGENERATION.
机构信息
Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California.
出版信息
Retina. 2018 Oct;38(10):1968-1976. doi: 10.1097/IAE.0000000000002198.
PURPOSE
To study choriocapillaris (CC) flow in eyes with Type 3 neovascularization (NV) and age-related macular degeneration, using optical coherence tomography angiography analysis.
METHODS
In this multicenter, retrospective, observational study, we collected data from 21 patients with unilateral Type 3 NV and age-related macular degeneration, based on clinical examination, structural optical coherence tomography, and fluorescein angiography when available. An additional group of 20 nonneovascular age-related macular degeneration eyes with unilateral Type 1 or Type 2 NV due to age-related macular degeneration was included for comparison. En face optical coherence tomography angiography imaging (3 × 3 mm scans) with quantitative microvascular analysis of the CC was performed. Main outcome measures were: 1) the percent nonperfused choriocapillaris area; and 2) the average CC signal void size.
RESULTS
We included 21 patients with unilateral Type 3 NV (15 female, 71.5%) and 20 patients with unilateral Type 1 or 2 NV (9 female, 45.0% P = 0.118). Mean ± SD age was 82.1 ± 7.4 years in the unilateral Type 3 patients and 78.3 ± 8.1 in unilateral Type 1/2 NV subjects (P = 0.392). The percent nonperfused choriocapillaris area was 56.3 ± 8.1% in eyes with Type 3 NV and 51.9 ± 4.3% in the fellow eyes (P = 0.016). The average signal void size was also increased in those eyes with Type 3 NV (939.9 ± 680.9 μm), compared with the fellow eyes (616.3 ± 304.2 μm, P = 0.039). The number of signal voids was reduced in the Type 3 NV eyes (604.5 ± 282.9 vs. 747.3 ± 195.8, P = 0.046). The subfoveal choroidal thickness was 135.9 ± 54.2 μm in eyes with Type 3 NV and 167.2 ± 65.4 μm in the fellow eyes (P = 0.003). In addition, the fellow eyes of patients with unilateral Type 3 NV displayed more significant CC flow abnormalities versus the fellow eyes with unilateral Type 1/2 NV (percent nonperfused choriocapillaris area = 51.9 ± 4.3% vs. 46.0 ± 2.1%, respectively, P < 0.0001; and average signal void size 616.3 ± 304.2 μm versus 351.4 ± 65.5 μm, respectively, P < 0.0001; and number of signal voids 747.3 ± 195.8 vs. 998.5 ± 147.3, respectively, P < 0.0001).
CONCLUSION
Eyes with unilateral Type 3 NV illustrated increased CC nonperfusion versus fellow nonneovascular eyes. These results suggest that choroidal ischemia may play an important role in the development of Type 3 NV.
目的
利用光相干断层扫描血管造影分析研究 3 型新生血管（NV）和年龄相关性黄斑变性患者的脉络膜毛细血管（CC）血流。
方法
在这项多中心、回顾性、观察性研究中，我们根据临床检查、结构光相干断层扫描和荧光素血管造影（如有），收集了 21 例单侧 3 型 NV 和年龄相关性黄斑变性患者的数据。还纳入了 20 例单侧因年龄相关性黄斑变性引起的 1 型或 2 型 NV 的非新生血管性年龄相关性黄斑变性眼作为对照。进行了面向的光相干断层扫描血管造影成像（3×3mm 扫描），并对 CC 进行了定量微血管分析。主要观察指标为：1）未灌注脉络膜毛细血管面积的百分比；2）平均 CC 信号缺失大小。
结果
我们纳入了 21 例单侧 3 型 NV 患者（女性 15 例，71.5%）和 20 例单侧 1 型或 2 型 NV 患者（女性 9 例，45.0%，P=0.118）。单侧 3 型患者的平均年龄为 82.1±7.4 岁，单侧 1/2NV 患者为 78.3±8.1 岁（P=0.392）。3 型 NV 眼中未灌注脉络膜毛细血管面积为 56.3±8.1%，而对侧眼为 51.9±4.3%（P=0.016）。3 型 NV 眼中的平均信号缺失大小也较大（939.9±680.9μm），而对侧眼为 616.3±304.2μm（P=0.039）。3 型 NV 眼中的信号缺失数量减少（604.5±282.9 与 747.3±195.8，P=0.046）。3 型 NV 眼中的脉络膜下厚度为 135.9±54.2μm，而对侧眼为 167.2±65.4μm（P=0.003）。此外，与单侧 1/2NV 相比，单侧 3 型 NV 患者的对侧眼显示出更明显的 CC 血流异常（未灌注脉络膜毛细血管面积百分比=51.9±4.3%与 46.0±2.1%，P<0.0001；平均信号缺失大小=616.3±304.2μm 与 351.4±65.5μm，P<0.0001；信号缺失数量=747.3±195.8 与 998.5±147.3，P<0.0001）。
结论
单侧 3 型 NV 眼与对侧非新生血管眼相比，CC 灌注不足增加。这些结果表明脉络膜缺血可能在 3 型 NV 的发生中起重要作用。
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