年龄相关性黄斑变性中地理萎缩伴随后发性渗出性新生血管病变的进展：AREDS2 报告 24。
Progression of Geographic Atrophy with Subsequent Exudative Neovascular Disease in Age-Related Macular Degeneration: AREDS2 Report 24.
机构信息
Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
出版信息
Ophthalmol Retina. 2021 Feb;5(2):108-117. doi: 10.1016/j.oret.2020.10.008. Epub 2020 Oct 16.
PURPOSE
To examine whether the rate of geographic atrophy (GA) enlargement is influenced by subsequent exudative neovascular age-related macular degeneration (nAMD) and hence, to explore indirectly whether nonexudative nAMD may slow GA enlargement.
DESIGN
Post hoc analysis of a controlled clinical trial cohort.
PARTICIPANTS
Age-Related Eye Disease Study 2 participants 50 to 85 years of age.
METHODS
Baseline and annual stereoscopic color fundus photographs were evaluated for (1) GA presence and area and (2) exudative nAMD presence. Two cohorts were constructed: eyes with GA at study baseline (prevalent cohort) and eyes in which GA developed during follow-up (incident cohort). Mixed-model regression of the square root of GA area was performed according to the presence or absence of subsequent exudative nAMD.
MAIN OUTCOME MEASURES
Change over time in square root of GA area.
RESULTS
Of the 757 eyes in the incident GA cohort, over a mean follow-up of 2.3 years (standard deviation [SD], 1.2 years), 73 eyes (9.6%) demonstrated subsequent exudative nAMD. Geographic atrophy enlargement in these eyes was significantly slower (0.20 mm/year; 95% confidence interval [CI], 0.12-0.28 mm/year) compared with the other 684 eyes in which subsequent exudative nAMD did not develop (0.29 mm/year; 95% CI, 0.27-0.30 mm/year; P = 0.037). Of the 456 eyes in the prevalent GA cohort, over a mean follow-up of 4.1 years (SD, 1.4 years), 63 eyes (13.8%) demonstrated subsequent exudative nAMD. Geographic atrophy enlargement in these eyes was similar (0.31 mm/year; 95% CI, 0.24-0.37 mm/year) compared with the other 393 eyes in which subsequent exudative nAMD did not develop (0.28 mm/year; 95% CI, 0.26-0.29 mm/year; P = 0.37).
CONCLUSIONS
In eyes with recent GA, GA enlargement before the development of exudative nAMD seems slowed. This association was not observed in eyes with more long-standing GA, which have larger lesion sizes. Hence, perilesional nonexudative choroidal neovascular tissue (presumably present before the development of clinically apparent exudation) may slow enlargement of smaller GA lesions through improved perfusion. This hypothesis warrants further evaluation in prospective studies.
目的
研究是否存在因随后发生渗出性新生血管性年龄相关性黄斑变性（nAMD）而导致脉络膜萎缩（GA）扩大的速度加快的情况，从而间接探讨非渗出性 nAMD 是否会减缓 GA 扩大的速度。
设计
对照临床试验队列的事后分析。
参与者
年龄相关性眼病研究 2 参与者，年龄在 50 至 85 岁之间。
方法
对基线和每年的立体彩色眼底照片进行评估，评估内容包括：（1）GA 的存在和面积；（2）渗出性 nAMD 的存在。构建了两个队列：研究基线时存在 GA 的眼睛（现患队列）和随访期间出现 GA 的眼睛（新发队列）。根据是否存在随后的渗出性 nAMD，对 GA 面积的平方根进行混合模型回归分析。
主要观察指标
GA 面积平方根随时间的变化。
结果
在新发 GA 队列的 757 只眼中，平均随访 2.3 年（标准差为 1.2 年），其中 73 只眼（9.6%）出现了随后的渗出性 nAMD。与其他 684 只眼（95%置信区间为 0.27-0.30mm/年）相比，这些眼的 GA 扩大速度明显较慢（0.20mm/年，95%置信区间为 0.12-0.28mm/年；P=0.037）。在现患 GA 队列的 456 只眼中，平均随访 4.1 年（标准差为 1.4 年），其中 63 只眼（13.8%）出现了随后的渗出性 nAMD。与其他 393 只眼（95%置信区间为 0.26-0.29mm/年）相比，这些眼的 GA 扩大速度相似（0.31mm/年，95%置信区间为 0.24-0.37mm/年；P=0.37）。
结论
在最近出现 GA 的眼中，在出现渗出性 nAMD 之前，GA 的扩大似乎有所减缓。这种关联在出现更长期 GA 的眼中并未观察到，这些眼中的病变更大。因此，推测在临床上出现渗出之前就存在的病灶周围无渗出性脉络膜新生血管组织可能通过改善灌注来减缓较小 GA 病变的扩大。这一假说需要在前瞻性研究中进一步评估。
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