Fragiotta Serena, Rossi Tommaso, Carnevale Carmela, Cutini Alessandro, Tricarico Stefano, Casillo Lorenzo, Scuderi Gianluca, Vingolo Enzo Maria
Department of Medico-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, C.so Della Repubblica, 79, 04100, Latina, (LT), Italy.
IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Graefes Arch Clin Exp Ophthalmol. 2019 Oct;257(10):2137-2146. doi: 10.1007/s00417-019-04418-8. Epub 2019 Jul 19.
To investigate the prevalence and progression of vitreo-macular interface disorders (VMID) phenotypes and their natural history in retinitis pigmentosa (RP).
A total of 257 eyes of 145 RP patients with VMID were retrospectively evaluated. Patients were divided according to the VMID subtypes into epiretinal membranes (ERMs), vitreo-macular traction (VMT) group, and macular hole (MH). Serial eye-tracked spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) changes were analyzed for a mean follow-up of 36.95 months. The status of posterior vitreous cortex was also considered. A control group of 65 eyes belonging to 65 RP patients with no macular changes was also recruited.
VMID and control groups had the same baseline BCVA (0.50 vs 0.44 LogMAR) and did not differ in terms of phakic status. Different VMID groups had similar BCVA at baseline (p = 0.98). ERM represented the most prevalent disorder (207/257 eyes, 80.5%), followed by 35/257 (13.6%) VMT, and 15/257 Lamellar MH (LMH) eyes (5.8%). There were no cases of full thickness MH. Throughout the 36.9 months of follow-up, BCVA decreased an average 0.09 LogMAR from 0.31 to 0.4 in VMID patients and 0.01 in controls. VMID subgroup analysis showed a significant BCVA decrease in ERM patients (- 20.29%, p < 0.001), while VMT and LMH did not change significantly. Foveal thickness also remained stable over time. Complete PVD was present in 11 eyes in ERM, VMT, and LMH.
Our study confirms the high prevalence of VMID in RP patients; however, only ERMs determined a significant loss of vision over 24 months. The high prevalence of VMID in RP patients suggests that macular alteration other than edema represents part of disease spectrum.
研究视网膜色素变性（RP）患者玻璃体黄斑界面疾病（VMID）表型的患病率、进展情况及其自然病程。
对145例患有VMID的RP患者的257只眼进行回顾性评估。根据VMID亚型将患者分为视网膜前膜（ERM）、玻璃体黄斑牵拉（VMT）组和黄斑裂孔（MH）组。分析连续眼跟踪光谱域光学相干断层扫描（SD-OCT）和最佳矫正视力（BCVA）的变化，平均随访36.95个月。还考虑了玻璃体后皮质的状态。招募了65例无黄斑变化的RP患者的65只眼作为对照组。
VMID组和对照组的基线BCVA相同（0.50对0.44 LogMAR），晶状体状态无差异。不同的VMID组在基线时BCVA相似（p = 0.98）。ERM是最常见的疾病（207/257只眼，80.5%），其次是35/257（13.6%）VMT和15/257板层黄斑裂孔（LMH）眼（5.8%）。无全层MH病例。在整个36.9个月的随访中，VMID患者的BCVA平均从0.31降至0.4，下降了0.09 LogMAR，对照组下降了0.01。VMID亚组分析显示ERM患者的BCVA显著下降（-20.29%，p < 0.001），而VMT和LMH无显著变化。随着时间的推移，黄斑中心凹厚度也保持稳定。ERM、VMT和LMH组中有11只眼出现了完全性玻璃体后脱离（PVD）。
我们的研究证实了VMID在RP患者中的高患病率；然而，只有ERM在24个月内导致了显著的视力丧失。RP患者中VMID的高患病率表明，除水肿外的黄斑改变是疾病谱的一部分。
