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.
Retina. 2018 Oct;38(10):1968-1976. doi: 10.1097/IAE.0000000000002198.
To study choriocapillaris (CC) flow in eyes with Type 3 neovascularization (NV) and age-related macular degeneration, using optical coherence tomography angiography analysis.
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.
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).
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.
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。
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。
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）。
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。
