Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA; Tianjin Medical University Eye Hospital, Tianjin, China.
Department of Bioengineering, University of Washington, Seattle, Washington, USA.
Am J Ophthalmol. 2019 Dec;208:1-11. doi: 10.1016/j.ajo.2019.06.017. Epub 2019 Jun 21.
Swept source optical coherence tomography angiography (SS-OCTA) was used to study the prevalence, incidence, and natural history of subclinical macular neovascularization (MNV) in eyes with unilateral nonexudative age-related macular degeneration.
Prospective cohort study.
Patients were imaged using 3- × 3-mm and 6- × 6-mm SS-OCTA scan patterns. MNV was detected using the outer retina to choriocapillaris en face slab. Prevalence and incidence of subclinical MNV, Kaplan-Meier cumulative estimates for the overall risk of exudation, and the association between neovascular lesion size and the risk of exudation were assessed through 2 years.
From August 2014 through March 2018, 227 patients (154 intermediate and 73 late age-related macular degeneration eyes) underwent SS-OCTA imaging. Thirty eyes (13.2%) had subclinical MNV at first imaging and 12 eyes (8.9%) developed subclinical MNV during follow-up. Of the 191 eyes with >1 visit, 19 developed exudation. Fourteen of these eyes had pre-existing subclinical MNV. The incidence of exudation from the time of first detection of any subclinical MNV was 34.5%. The relative risk of exudation after detection of subclinical MNV was 13.6 times greater (95% confidence interval 4.9-37.7) than in the absence of subclinical MNV (P < .001). There was no significant risk of exudation based on lesion size alone (P = .91).
By 24 months, the risk of exudation was 13.6 times greater for eyes with subclinical MNV detected by SS-OCTA compared with eyes without subclinical MNV. For eyes with subclinical MNV in the absence of symptomatic exudation, we recommend close follow-up without treatment.
应用扫频源光学相干断层血管造影术（SS-OCTA）研究单侧非渗出性年龄相关性黄斑变性（AMD）患者亚临床黄斑新生血管（MNV）的患病率、发病率和自然史。
前瞻性队列研究。
使用 3×3mm 和 6×6mm SS-OCTA 扫描模式对患者进行成像。使用外视网膜到脉络膜毛细血管的外生板来检测 MNV。通过 2 年的时间评估亚临床 MNV 的患病率和发病率、渗出的总体风险的Kaplan-Meier 累积估计值，以及新生血管病变大小与渗出风险之间的关系。
2014 年 8 月至 2018 年 3 月，227 例患者（154 例中期 AMD 眼和 73 例晚期 AMD 眼）接受了 SS-OCTA 成像。首次成像时 30 只眼（13.2%）存在亚临床 MNV，随访期间 12 只眼（8.9%）发生亚临床 MNV。在 191 只至少接受过一次随访的眼中，有 19 只出现渗出。其中 14 只眼有预先存在的亚临床 MNV。从首次发现任何亚临床 MNV 到出现渗出的时间，其渗出发生率为 34.5%。在存在亚临床 MNV 后发生渗出的相对风险是不存在亚临床 MNV 的 13.6 倍（95%置信区间 4.9-37.7）（P<0.001）。仅根据病变大小，没有明显的渗出风险（P=0.91）。
与没有亚临床 MNV 的眼睛相比，通过 SS-OCTA 检测到亚临床 MNV 的眼睛在 24 个月时发生渗出的风险增加了 13.6 倍。对于没有症状性渗出的亚临床 MNV 患者，建议密切随访而无需治疗。
