NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
UCL Institute of Ophthalmology, London, United Kingdom.
Ophthalmic Res. 2020;63(4):375-382. doi: 10.1159/000505628. Epub 2019 Dec 30.
To investigate the longitudinal correlation between drusen characteristics and retinal layer volumes pre conversion and subsequent type of choroidal neovascularisation (CNV).
This was a single-centre retrospective study. The study participants were patients with wet age-related macular degeneration (AMD) in one eye who developed wet AMD in the contralateral eye, with at least 2 years of follow-up prior to conversion. The Moorfields Eye Hospital database was searched for eligible patients and their data were recorded. Eyes were classified as occult or classic based on fundus fluorescein angiography. Optical coherence tomography (OCT) images were analysed for drusen characteristics and retinal layer volumes were analysed over time using automated software (Topcon 3D OCT-2000 and Orion, Voxeleron LLC, respectively). All values were obtained at baseline as well as year 1 and year 2 before conversion to wet AMD.
Fifty-one eyes with bilateral CNV showed high correlation of type of CNV between eyes (kappa statistic 0.89). A total of 49 wet AMD eyes (29 occult, 20 classic) were analysed for drusen parameters. Two patients with retinal angiomatous proliferation were excluded. Drusen count, area, and volume did not differ by CNV type, but the rates of change of drusen area (p = 0.046) and drusen volume (0.022) were higher in the occult group in the year preceding CNV development. Of the 49 eyes, 17 (10 occult, 7 classic) with available good quality OCT were analysed for retinal layer volumes. There was a progressive reduction in outer nuclear layer (ONL) volume (p = 0.002) and an expansion in outer plexiform layer volume (p = 0.015) in eyes that developed occult CNV.
Our study shows that rate of increase in drusen load and reduction in ONL are significant features seen in eyes developing occult CNV, highlighting new imaging markers that need to be replicated in larger studies. These markers provide insight into the pathogenesis of CNV and may serve as prognostic indicators, as classic CNV carries a poorer prognosis compared to occult CNV.
研究在向脉络膜新生血管（CNV）转化之前和之后，玻璃膜疣特征与视网膜层体积之间的纵向相关性。
这是一项单中心回顾性研究。研究参与者为一只眼患有湿性年龄相关性黄斑变性（AMD）的患者，这些患者在向湿性 AMD 转化之前至少有 2 年的随访期，而对侧眼发生了湿性 AMD。在 Moorfields Eye Hospital 数据库中搜索符合条件的患者，并记录其数据。根据眼底荧光血管造影将眼睛分为隐匿型或经典型。使用自动软件（Topcon 3D OCT-2000 和 Orion，Voxeleron LLC）对光学相干断层扫描（OCT）图像进行分析，以研究玻璃膜疣特征，并随时间分析视网膜层体积。所有值均在向湿性 AMD 转化之前的基线以及第 1 年和第 2 年获得。
51 只双眼均患有 CNV 的眼睛显示出 CNV 类型之间具有高度相关性（kappa 统计量 0.89）。对 49 只患有湿性 AMD 的眼睛（29 只隐匿型，20 只经典型）进行了玻璃膜疣参数分析。排除了 2 例视网膜血管瘤样增生的患者。CNV 类型之间玻璃膜疣计数、面积和体积没有差异，但在 CNV 发展前一年，隐匿型玻璃膜疣的面积（p = 0.046）和体积（0.022）的变化率更高。在这 49 只眼中，有 17 只（10 只隐匿型，7 只经典型）具有良好质量的 OCT 可用于分析视网膜层体积。在发生隐匿型 CNV 的眼中，外核层（ONL）体积逐渐减少（p = 0.002），外丛状层体积扩大（p = 0.015）。
我们的研究表明，在向隐匿型 CNV 发展的眼中，玻璃膜疣负荷的增加速度和 ONL 的减少是显著特征，突出了需要在更大研究中复制的新成像标志物。这些标志物为 CNV 的发病机制提供了深入了解，并可能成为预后指标，因为与隐匿型 CNV 相比，经典型 CNV 的预后更差。
