Sacconi Riccardo, Sarraf David, Garrity Sean, Freund K Bailey, Yannuzzi Lawrence A, Gal-Or Orly, Souied Eric, Sieiro André, Corbelli Eleonora, Carnevali Adriano, Querques Lea, Bandello Francesco, Querques Giuseppe
Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy; Eye Clinic, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy.
Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California.
Ophthalmol Retina. 2018 Nov;2(11):1097-1106. doi: 10.1016/j.oret.2018.04.016. Epub 2018 May 25.
To describe the preclinical and very early stages of type 3 neovascularization using multimodal retinal imaging to expand our understanding of the pathogenesis of this disorder and potentially to prevent late treatment.
Retrospective cohort study.
Patients diagnosed with treatment-naïve type 3 neovascularization in the setting of age-related macular degeneration were identified at 4 retina referral centers. Inclusion criteria were: patients older than 55 years with at least 1 OCT and OCT angiography (OCTA) examination before the onset of clinically active type 3 neovascularization (i.e., preclinical stage).
Patients underwent a complete ophthalmologic examination including at least OCT and OCTA at the baseline and preclinical stage examinations, and dye angiographies when available. Demographics and clinical findings were analyzed.
Description of multimodal imaging features of nascent type 3 neovascularization.
Fifteen eyes (15 patients; mean age, 83 ± 9 years) were included. At the baseline, mean BCVA was 0.32 ± 0.17 logarithm of the minimum angle of resolution and central macular thickness was 313 ± 50 μm. Preclinical (i.e., prebaseline) structural OCT illustrated the presence of intraretinal hyperreflective foci (HRF) at the site of type 3 neovascularization development in all patients. These foci were characterized by hyperfluorescence on dye angiography and by detectable flow on OCTA, identified with either the avascular slab (20%) or with both the deep retinal capillary plexus (DCP) and avascular slabs (80%). Typically, HRF with detectable flow on OCTA were characterized by the absence of intraretinal exudation (or very mild microcystic changes) until the lesion progressed from the DCP into the retinal pigment epithelium (RPE) and sub-RPE space. Of note, in 1 patient we observed the complete resolution of HRF despite the presence of OCTA flow and dye angiography hyperfluorescence detected at the preclinical stage examination.
Hyperreflective foci on structural OCT may represent early intraretinal neovascularization originating from the DCP, namely nascent type 3 neovascularization; these lesions can progress to active type 3 neovascularization or more rarely may regress without functional impairment. An advanced multimodal imaging approach is useful in detecting nascent type 3 lesions, which should be followed up carefully and treated as soon as possible if flow progresses to the RPE and sub-RPE space to prevent progression to late stages.
利用多模态视网膜成像描述3型新生血管形成的临床前和极早期阶段，以加深我们对这种疾病发病机制的理解，并有可能预防晚期治疗。
回顾性队列研究。
在4个视网膜转诊中心确定了年龄相关性黄斑变性患者中未经治疗的3型新生血管形成患者。纳入标准为：年龄大于55岁，在临床活跃的3型新生血管形成（即临床前阶段）发作前至少进行过1次光学相干断层扫描（OCT）和光学相干断层扫描血管造影（OCTA）检查。
患者在基线和临床前阶段检查时接受了包括至少OCT和OCTA在内的完整眼科检查，如有条件还进行了染料血管造影。分析了人口统计学和临床发现。
描述新生3型新生血管形成的多模态成像特征。
纳入15只眼（15例患者；平均年龄83±9岁）。基线时，平均最佳矫正视力（BCVA）为最小分辨角对数的0.32±0.17，中心黄斑厚度为313±50μm。临床前（即基线前）结构OCT显示，所有患者在3型新生血管形成部位均存在视网膜内高反射灶（HRF）。这些病灶在染料血管造影上表现为高荧光，在OCTA上表现为可检测到的血流，可通过无血管层（20%）或视网膜深层毛细血管丛（DCP）和无血管层两者（80%）识别。通常，在OCTA上有可检测到血流的HRF的特征是，在病变从DCP进展到视网膜色素上皮（RPE）和RPE下间隙之前，不存在视网膜内渗出（或非常轻微的微囊性改变）。值得注意的是，在1例患者中，尽管在临床前阶段检查中检测到OCTA血流和染料血管造影高荧光，但我们观察到HRF完全消退。
结构OCT上的高反射灶可能代表起源于DCP的早期视网膜内新生血管形成，即新生3型新生血管形成；这些病变可进展为活跃的3型新生血管形成，或更罕见地可能在无功能损害的情况下消退。先进的多模态成像方法有助于检测新生3型病变，如果血流进展到RPE和RPE下间隙，应仔细随访并尽快治疗，以防止进展到晚期。
