Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Nottingham University Hospitals NHS Trust, Nottingham, UK.
Int Ophthalmol. 2020 Jun;40(6):1501-1508. doi: 10.1007/s10792-020-01319-2. Epub 2020 Mar 4.
Adult vitelliform lesions (AVL) are associated with age related macular degeneration (AMD) and subretinal drusenoid deposits (SRDD). We evaluated the natural course of AVL, assessing the influence of SRDD on disease progression, visual function and incidence of macular atrophy (MA) and choroidal neovascular membranes (CNVM).
A retrospective cohort study was conducted between January 2011 and March 2016. Demographic, clinical and imaging data from 26 consecutive AVL patients were analysed following case note review. Optical coherence tomography images were graded for SRDD and patients divided into those with/without SRDD. Outcomes included presenting/changes in best corrected visual acuity (BCVA) and incidence of MA/CNVM.
Mean age was 78.6 ± 7.6 years. Mean follow-up was 51.5 ± 25.6 months. Twelve patients (46.2%) had SRDD at presentation with 3 more (11.5%) developing them. Subjects with SRDD were older (mean 81.7 ± 6.1 years vs 74.3 ± 7.6 years, p = 0.010). Mean presenting BCVA was worse in SRDD eyes (0.39 ± 0.31 logMAR vs 0.19 ± 0.18 logMAR, p = 0.017). Eight of 15 patients with SRDD (53.3%) developed incident MA or CNVM; higher than those with no SRDD (1/11, 9.1%; p = 0.036). Two patients (7.7%) developed full thickness macular holes.
Patients with AVL and SRDD likely represent an advanced pathological stage or phenotype with worse visual outcome and higher risk of MA/CNVM. Possible overlap with AMD exists. Follow-up, counselling and provisions for early detection/treatment of complications should be made. Better classification including improved understanding of phenotypic and genetic variations with reference to comorbid diseases including AMD is required. Presence of SRDD in AVL offers a dichotomous classification, indicating risk of future MA/CNVM formation.
成人型类玻璃膜疣（AVL）与年龄相关性黄斑变性（AMD）和视网膜下类脂沉积（SRDD）有关。我们评估了 AVL 的自然病程，评估了 SRDD 对疾病进展、视觉功能以及黄斑萎缩（MA）和脉络膜新生血管膜（CNVM）发生的影响。
这是一项回顾性队列研究，于 2011 年 1 月至 2016 年 3 月进行。通过病历回顾分析了 26 例连续 AVL 患者的人口统计学、临床和影像学数据。对 SRDD 进行光学相干断层扫描图像分级，并根据是否存在 SRDD 将患者分为两组。结果包括最佳矫正视力（BCVA）的初始和变化以及 MA/CNVM 的发生率。
平均年龄为 78.6±7.6 岁。平均随访时间为 51.5±25.6 个月。12 例（46.2%）患者在就诊时存在 SRDD，其中 3 例（11.5%）出现 SRDD。有 SRDD 的患者年龄较大（平均 81.7±6.1 岁比 74.3±7.6 岁，p=0.010）。SRDD 眼的初始 BCVA 更差（0.39±0.31 logMAR 比 0.19±0.18 logMAR，p=0.017）。15 例有 SRDD 的患者中有 8 例（53.3%）出现新发 MA 或 CNVM；高于无 SRDD 的患者（11 例中的 1 例，9.1%；p=0.036）。2 例（7.7%）患者发生全层黄斑裂孔。
患有 AVL 和 SRDD 的患者可能代表了一种晚期的病理阶段或表型，其视觉结果更差，发生 MA/CNVM 的风险更高。可能与 AMD 存在重叠。应进行随访、咨询，并为并发症的早期发现/治疗做好准备。需要更好的分类，包括更好地理解与 AMD 等合并症相关的表型和遗传变异。AVL 中存在 SRDD 提供了一种二分法分类，表明未来发生 MA/CNVM 的风险。
