Department of Ophthalmology and Vision Sciences, University of California, Davis, Sacramento.
George Washington University School of Medicine and Health Sciences, Washington, DC.
JAMA Ophthalmol. 2018 Sep 1;136(9):1008-1014. doi: 10.1001/jamaophthalmol.2018.2650.
A hemodynamic role in the pathogenesis of age-related macular degeneration (AMD) has been proposed, but to our knowledge, an association between retinal vasculature and late AMD has not been investigated.
To determine whether the presence and location of a cilioretinal artery may be associated with the risk of late AMD in the Age-Related Eye Disease Study (AREDS).
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of prospective, randomized clinical trial data from 3647 AREDS participants. Fundus photographs of AREDS participants were reviewed by 2 masked graders for the presence or absence of a cilioretinal artery and whether any branch extended within 500 μm of the central macula. Multivariate regressions were used to determine the association of the cilioretinal artery and vessel location, adjusted for age, sex, and smoking status, with the prevalence of choroidal neovascularization (CNV) or central geographic atrophy (CGA) and AMD severity score for eyes at randomization and progression at 5 years.
Association of cilioretinal artery with prevalence and 5-year incidence of CNV or CGA.
Among AREDS participants analyzed, mean (SD) age was 69.0 (5.0) years, with 56.3% female, 46.6% former smokers, and 6.9% current smokers. A total of 26.9% of patients had a cilioretinal artery in 1 eye, and 8.4% had the vessel bilaterally. At randomization, eyes with a cilioretinal artery had a lower prevalence of CNV (5.0% vs 7.6%; OR, 0.66; 95% CI, 0.51-0.85; P = .001) but no difference in CGA (1.1% vs 0.8%; OR, 1.33; 95% CI, 0.76-2.32; P = .31). In eyes without late AMD, those with a cilioretinal artery also had a lower mean (SD) AMD severity score (3.00 [2.35] vs 3.19 [2.40]; P = .02). At 5 years, eyes at risk with a cilioretinal artery had lower rates of progression to CNV (4.1% vs 5.5%; OR, 0.75; 95% CI, 0.56-1.00; P = .05) but no difference in developing CGA (2.2% vs 2.7%; OR, 0.83; 95% CI, 0.56-1.23; P = .35) or change in AMD severity score (0.65 [1.55] vs 0.73 [1.70]; P = .11). In patients with a unilateral cilioretinal artery, eyes with the vessel showed a lower prevalence of CNV than fellow eyes (4.7% vs 7.2%; P = .01).
The presence of a cilioretinal artery is associated with a lower risk of developing CNV, but not CGA, suggesting a possible retinal hemodynamic contribution to the pathogenesis of neovascular AMD.
ClinicalTrials.gov Identifier: NCT00000145.
已经提出了血管舒缩在年龄相关性黄斑变性（AMD）发病机制中的作用，但据我们所知，尚未研究视网膜血管与晚期 AMD 之间的关系。
确定睫状视网膜动脉的存在和位置是否与年龄相关性眼病研究（AREDS）中晚期 AMD 的风险相关。
设计、设置和参与者：对 3647 名 AREDS 参与者的前瞻性、随机临床试验数据进行回顾性分析。通过 2 名盲法评分员对 AREDS 参与者的眼底照片进行评估，以确定是否存在睫状视网膜动脉，以及任何分支是否延伸至中央黄斑 500 μm 以内。使用多元回归来确定睫状视网膜动脉和血管位置与脉络膜新生血管（CNV）或中央地理萎缩（CGA）的患病率以及随机时和 5 年时 AMD 严重程度评分的相关性，调整了年龄、性别和吸烟状况。
睫状视网膜动脉与 CNV 或 CGA 的患病率和 5 年发生率的关系。
在分析的 AREDS 参与者中，平均（SD）年龄为 69.0（5.0）岁，女性占 56.3%，前吸烟者占 46.6%，现吸烟者占 6.9%。共有 26.9%的患者在 1 只眼中有睫状视网膜动脉，8.4%的患者双眼均有该血管。在随机时，有睫状视网膜动脉的眼睛 CNV 患病率较低（5.0% vs 7.6%；OR，0.66；95%CI，0.51-0.85；P = .001），但 CGA 无差异（1.1% vs 0.8%；OR，1.33；95%CI，0.76-2.32；P = .31）。在没有晚期 AMD 的眼睛中，有睫状视网膜动脉的眼睛也有较低的平均（SD）AMD 严重程度评分（3.00 [2.35] vs 3.19 [2.40]；P = .02）。在 5 年时，有睫状视网膜动脉的高危眼发生 CNV 的比例较低（4.1% vs 5.5%；OR，0.75；95%CI，0.56-1.00；P = .05），但发生 CGA 的比例无差异（2.2% vs 2.7%；OR，0.83；95%CI，0.56-1.23；P = .35）或 AMD 严重程度评分的变化（0.65 [1.55] vs 0.73 [1.70]；P = .11）。在单侧睫状视网膜动脉的患者中，有血管的眼睛与对侧眼睛相比，CNV 的患病率较低（4.7% vs 7.2%；P = .01）。
睫状视网膜动脉的存在与发生 CNV 的风险降低相关，但与 CGA 无关，提示新生血管性 AMD 的发病机制中可能存在视网膜血管舒缩作用。
ClinicalTrials.gov 标识符：NCT00000145。
