年龄相关性眼病研究2期家庭研究中脉络膜新生血管病变的影像学特征：报告编号4
Imaging Characteristics of Choroidal Neovascular Lesions in the AREDS2-HOME Study: Report Number 4.
作者信息
Domalpally Amitha, Clemons Traci E, Bressler Susan B, Danis Ronald P, Elman Michael, Kim Judy E, Brown David, Chew Emily Y
机构信息
Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
The EMMES Corporation, Rockville, Maryland.
出版信息
Ophthalmol Retina. 2019 Apr;3(4):326-335. doi: 10.1016/j.oret.2019.01.004. Epub 2019 Jan 11.
PURPOSE
To characterize choroidal neovascular (CNV) lesions and the corresponding change in visual acuity (VA) in eyes that converted to neovascular age-related macular degeneration (AMD) in the Age-Related Eye Disease Study 2-HOme Monitoring of the Eye Study. (AREDS2-HOME Study).
DESIGN
Cohort study.
PARTICIPANTS
A total of 1520 participants at risk of developing CNV were enrolled, each of whom contributed 1 or both study eye(s) that had a best-corrected VA letter score of ≥54 letters (Snellen equivalent 20/60) and ≥1 large (≥125 μm) macular druse in the absence of neovascular AMD or central geographic atrophy.
METHODS
A multicenter clinical trial comparing standard care (SC) versus SC plus ForeseeHome (FH; Notal Vision, Manassas, VA) monitoring strategy in the detection of neovascular AMD. Fluorescein angiograms (FA) and OCT were evaluated by an independent reading center (RC) from the visit in which the ophthalmologist identified progression to CNV (n = 82 eyes).
MAIN OUTCOME MEASURES
Development of CNV on OCT, FA, or both.
RESULTS
The RC confirmed CNV in 67 of 82 eyes (82%); lesions were confirmed in 42 of 70 eyes (60%) with FA, 59 of 72 eyes (82%) with OCT, and on both images in 34 of 67 eyes (51%). Among the FA-confirmed cases, the median lesion size was 0.82 disc area (DA); lesions were subfoveal in 40.5%, occult CNV composition was present in 54.8%, and associated hemorrhage in 50%. Median (interquartile range [IQR]) lesion size on FA was 0.23 (0.0-0.91) DA versus 0.70 (0.0-1.50) DA, P = 0.051) in the FH and SC eyes, respectively. Among the OCT-confirmed cases median (IQR) center point thickness was 209 (175-274) μm, retinal pigment epithelial lesion complex was present in 86.4%, and subretinal fluid (SRF) was present in 76.3%. The median change in VA from baseline was -4.0 letters and -10.0 letters in the FH and SC eyes (P = 0.008) confirmed as CNV at the RC.
CONCLUSIONS
Incident CNV lesions were more prevalent on OCT images than on FA; however, the use of both OCT and FA enhanced detection of incident lesions. Lesions were smaller and associated with less vision loss among eyes in the FH group.
目的
在年龄相关性眼病研究2-家庭眼部监测研究（AREDS2-家庭研究）中，对转变为新生血管性年龄相关性黄斑变性（AMD）的眼睛中的脉络膜新生血管（CNV）病变以及相应的视力（VA）变化进行特征描述。
设计
队列研究。
参与者
共招募了1520名有发生CNV风险的参与者，每人提供1只或2只研究眼，这些眼睛在无新生血管性AMD或中心性地理性萎缩的情况下，最佳矫正视力字母评分≥54分（Snellen等效值20/60）且有≥1个大的（≥125μm）黄斑玻璃疣。
方法
一项多中心临床试验，比较标准护理（SC）与SC加ForeseeHome（FH；Notal Vision，弗吉尼亚州马纳萨斯）监测策略在检测新生血管性AMD方面的效果。荧光素血管造影（FA）和光学相干断层扫描（OCT）由一个独立阅片中心（RC）在眼科医生确定进展为CNV的就诊时进行评估（n = 82只眼）。
主要观察指标
OCT、FA或两者上CNV的发生情况。
结果
RC在82只眼中确认了67只（82%）存在CNV病变；FA在70只眼中确认了42只（60%）有病变，OCT在72只眼中确认了59只（82%）有病变，67只眼中有34只（51%）在两种图像上均有病变。在FA确认的病例中，病变大小中位数为0.82视盘面积（DA）；40.5%的病变位于黄斑中心凹下，54.8%为隐匿性CNV成分，50%伴有出血。FA上病变大小中位数（四分位间距[IQR]）在FH组和SC组眼中分别为0.23（0.0 - 0.91）DA和0.70（0.0 - 1.50）DA，P = 0.051）。在OCT确认的病例中，中心点厚度中位数（IQR）为209（175 - 274）μm，86.4%存在视网膜色素上皮病变复合体，76.3%存在视网膜下液（SRF）。在RC确认有CNV的FH组和SC组眼中，VA从基线的变化中位数分别为-4.0分和-10.0分（P = 0.008）。
结论
OCT图像上的新发CNV病变比FA上更常见；然而，同时使用OCT和FA可提高新发病变的检测率。FH组眼中的病变较小且视力丧失较少。
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