Toth Cynthia A, Tai Vincent, Pistilli Maxwell, Chiu Stephanie J, Winter Katrina P, Daniel Ebenezer, Grunwald Juan E, Jaffe Glenn J, Martin Daniel F, Ying Gui-Shuang, Farsiu Sina, Maguire Maureen G
Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Biomedical Engineering, Duke University, Durham, North Carolina.
Department of Ophthalmology, Duke University, Durham, North Carolina.
Ophthalmol Retina. 2019 Apr;3(4):316-325. doi: 10.1016/j.oret.2018.11.011. Epub 2018 Dec 3.
Macular atrophy and scar increase in prevalence during treatment for neovascular age-related macular degeneration and are associated with poor visual acuity. We sought to identify the distribution of spectral-domain OCT (SD-OCT)-determined features and subretinal lesion thicknesses at sites of macular scar or atrophy after 2 years of treatment in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).
Cross-sectional analysis.
CATT participants with SD-OCT, color photographic (CP) and fluorescein angiogram (FA; CP/FA) images at year 2.
Sixty-eight study eyes at year 2 in CATT were selected based on image quality and CP/FA-determined predominant presence of the following: geographic atrophy (GA, n = 25), non-GA (NGA, n = 44), fibrotic scar (FS, n = 26), or non-FS (NFS, n = 7). The CP/FA components were delineated by CP/FA readers; SD-OCT morphologic features and thicknesses were delineated by OCT readers. Using custom software and graphic user interfaces, images were registered, overlaying features and components per pixel; differences were analyzed across groups.
OCT features, CP/FA components, and retinal and subretinal lesion thicknesses at each pixel of regional overlays.
SD-OCT assessment of registered areas of pathology revealed the following: (1) retinal pigment epithelium atrophy (with or without residual lesion material) covered 75% of pixels designated as GA, 22% of NGA, 24% of NFS, and 46% of FS (P < 0.001). (2) Photoreceptor layer thinning covered 85% of GA, 42% of NGA, 33% of NFS, and 59% of FS (P < 0.001). (3) Subretinal lesion features covered 31% of GA, 42% of NGA, 85% of NFS, and 92% of FS (P < 0.001). Mean thickness of the subretinal lesion complex (measured in microns ± standard deviation) differed among GA (48±25 μm), NGA (61±35 μm), NFS (83±17 μm), and FS (151±74 μm) (P < 0.001). In eyes with GA, the thickness was greater in areas with residual lesion (51.4±27 μm) than in those without (27.2±9 μm).
Retinal pigment epithelium atrophy and photoreceptor layer thinning are common not only in areas of macular atrophy but also in areas of FS. Photoreceptor loss extends beyond the areas of clinically apparent atrophy and FS. Subretinal lesion components were common in areas of scar, but they were also present in nearly one-third or more of areas of macular atrophy.
在新生血管性年龄相关性黄斑变性的治疗过程中，黄斑萎缩和瘢痕的患病率会增加，且与视力不佳相关。我们试图在年龄相关性黄斑变性治疗试验（CATT）中，确定治疗2年后黄斑瘢痕或萎缩部位经光谱域光学相干断层扫描（SD-OCT）测定的特征分布以及视网膜下病变厚度。
横断面分析。
CATT中在第2年有SD-OCT、彩色照片（CP）和荧光素血管造影（FA；CP/FA）图像的参与者。
根据图像质量以及CP/FA确定的以下情况的主要存在情况，在CATT的第2年选择了68只研究眼：地图样萎缩（GA，n = 25）、非GA（NGA，n = 44）、纤维化瘢痕（FS，n = 26）或非FS（NFS，n = 7）。CP/FA成分由CP/FA阅片者划定；SD-OCT形态学特征和厚度由OCT阅片者划定。使用定制软件和图形用户界面，对图像进行配准，使每个像素的特征和成分叠加；对各组间的差异进行分析。
区域叠加图每个像素处的OCT特征、CP/FA成分以及视网膜和视网膜下病变厚度。
对登记的病变区域进行SD-OCT评估发现：（1）视网膜色素上皮萎缩（有或无残留病变物质）覆盖了指定为GA区域的75%的像素、NGA区域的22%的像素、NFS区域的24%的像素和FS区域的46%的像素（P < 0.001）。（2）光感受器层变薄覆盖了GA区域的85%的像素、NGA区域的42%的像素、NFS区域的33%的像素和FS区域的59%的像素（P < 0.001）。（3）视网膜下病变特征覆盖了GA区域的31%的像素、NGA区域的42%的像素、NFS区域的85%的像素和FS区域的92%的像素（P < 0.001）。视网膜下病变复合体的平均厚度（以微米±标准差测量）在GA（48±25μm）、NGA（61±35μm）、NFS（83±17μm）和FS（151±74μm）之间存在差异（P < 0.001）。在有GA的眼中，有残留病变区域的厚度（51.4±27μm）大于无残留病变区域的厚度（27.2±9μm）。
视网膜色素上皮萎缩和光感受器层变薄不仅在黄斑萎缩区域常见。光感受器丧失超出了临床明显萎缩和FS区域。视网膜下病变成分在瘢痕区域常见，但在近三分之一或更多的黄斑萎缩区域也存在。
