School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Br J Ophthalmol. 2021 Jan;105(1):97-102. doi: 10.1136/bjophthalmol-2019-315800. Epub 2020 Mar 22.
To analyse the choriocapillaris (CC) flow status in the area that subsequently showed geographic atrophy (GA) expansion secondary to age-related macular degeneration (AMD) during 1-year follow-up, matching optical coherence tomography angiography (OCT-A) and fundus autofluorescence (FAF).
In this prospective longitudinal observational study, 30 eyes of 20 consecutive patients with GA secondary to AMD (mean age 75.5±7.4 years) were included. All patients underwent OCT-A and FAF at baseline and 1-year follow-up. Main outcome measures included analysis of perfusion density (PD) in the 'area surrounding GA margin' (between the GA border and 500 µm distance) in comparison with the 'control area' (area outside the 500 µm line), and of the 'expansion area' (area that subsequently developed GA expansion during 1-year follow-up).
During the 1-year follow-up, visual acuity significantly decreased from 0.34±0.38 Logarithm of the Minimum Angle of Resolution (LogMAR) to 0.39±0.40 LogMAR (p<0.001), and mean GA area increased from 6.82±5.47 mm to 8.76±6.28 mm (p<0.001). CC PD of the area surrounding the GA margin revealed a significant flow impairment compared with control area (PD 0.679±0.076 and 0.734±0.057, respectively (p<0.001)). Furthermore, the PD of the expansion area showed a greater CC flow impairment in comparison to the remaining area surrounding GA margin (p<0.001).
We reported a greater CC impairment in the area that subsequently developed GA expansion, suggesting that the CC flow impairment could predict the enlargement of GA lesion. The CC impairment could be considered as a new a risk factor for GA progression and a biomarker to be measured to determine efficacy of new interventions aiming to slow progression of GA.
分析年龄相关性黄斑变性（AMD）继发地图状萎缩（GA）扩展过程中脉络膜毛细血管（CC）的血流状态，采用光学相干断层扫描血管造影（OCT-A）和眼底自发荧光（FAF）进行匹配。
本前瞻性纵向观察性研究纳入了 20 例连续患者的 30 只眼，这些患者均为 AMD 继发 GA（平均年龄 75.5±7.4 岁）。所有患者在基线和 1 年随访时均接受了 OCT-A 和 FAF 检查。主要观察指标包括分析“GA 边界周围区域”（GA 边界和 500µm 距离之间）与“对照区域”（500µm 线以外的区域）的灌注密度（PD），以及分析“扩展区域”（在 1 年随访期间随后发生 GA 扩展的区域）的 PD。
在 1 年的随访期间，视力从 0.34±0.38 对数最小分辨角（LogMAR）显著下降到 0.39±0.40 LogMAR（p<0.001），平均 GA 面积从 6.82±5.47mm 增加到 8.76±6.28mm（p<0.001）。GA 边缘周围区域的 CC PD 与对照区域相比显示出明显的血流受损（PD 分别为 0.679±0.076 和 0.734±0.057，p<0.001）。此外，与剩余的 GA 边缘周围区域相比，扩展区域的 PD 显示出更大的 CC 血流受损（p<0.001）。
我们报道了在随后发生 GA 扩展的区域中存在更大的 CC 损伤，这表明 CC 血流损伤可能预测 GA 病变的扩大。CC 损伤可被视为 GA 进展的新危险因素，也可作为一种生物标志物来衡量新干预措施的疗效，这些新干预措施旨在减缓 GA 的进展。
