Department of Ophthalmology, University Vita-Salute San Raffaele, Via Olgettina 60, Milan, Italy.
IRCCS San Raffaele Scientific Institute, Milan, Italy.
Sci Rep. 2020 Nov 23;10(1):20344. doi: 10.1038/s41598-020-77566-1.
The aim of this study was to explore the relative prevalence and clinical differences between age-related macular degeneration (AMD) and pachychoroid disease in patients older than 50 years with newly diagnosed exudative neovascular maculopathy, and also assess the rate of misdiagnosis between these two disorders. In this retrospective observational study, we reviewed data from patients 50 years of age and older with newly diagnosed treatment-naïve exudative macular neovascularization (MNV) secondary to AMD or pachychoroid disease. Of the 139 patients (139 eyes) who fulfilled the inclusion criteria, 35 patients were graded as being affected by pachychoroid disease complicated by exudative MNV and 104 subjects had neovascular AMD. Therefore, prevalence of pachychoroid disease complicated by exudative MNV was 25.2% (confidence interval-CI 18.2-33.2%). Mean ± SD age was 67.0 ± 8.8 years in the pachychoroid disease group and 80.6 ± 6.6 years in the neovascular AMD group (P < 0.0001). At baseline, BCVA was better in patients with pachychoroid disease complicated by exudative MNV (0.4 ± 0.3 LogMAR vs. 0.7 ± 0.5 LogMAR, P = 0.003). At the 1-year follow-up visit, BCVA was still better in patients with pachychoroid-associated MNV (0.34 ± 0.32 LogMAR vs. 0.59 ± 0.52 LogMAR; P = 0.005). In our study cohort, 19 patients were graded to be affected by pachychoroid disease complicated by exudative MNV even though a diagnosis of neovascular AMD was erroneously reported in their medical records at baseline. In conclusion, pachychoroid disease is a frequent cause of exudative MNV in aged patients with a high rate of misdiagnosis. A correct diagnosis may be important as these two disorders differ in terms of clinical characteristics and prognosis.
本研究旨在探讨年龄相关性黄斑变性（AMD）和厚脉络膜疾病在 50 岁以上新发渗出性新生血管性黄斑病变患者中的相对患病率和临床差异，并评估这两种疾病之间的误诊率。在这项回顾性观察研究中，我们对年龄在 50 岁及以上、新诊断为治疗初发性渗出性黄斑新生血管化（MNV）继发于 AMD 或厚脉络膜疾病的患者的数据进行了回顾。在符合纳入标准的 139 例患者（139 只眼）中，35 例患者被诊断为厚脉络膜疾病合并渗出性 MNV，104 例患者为新生血管性 AMD。因此，厚脉络膜疾病合并渗出性 MNV 的患病率为 25.2%（置信区间 CI 18.2-33.2%）。厚脉络膜疾病组的平均年龄为 67.0±8.8 岁，新生血管性 AMD 组为 80.6±6.6 岁（P<0.0001）。在基线时，厚脉络膜疾病合并渗出性 MNV 患者的 BCVA 更好（0.4±0.3 LogMAR 与 0.7±0.5 LogMAR，P<0.0001）。在 1 年随访时，厚脉络膜相关性 MNV 患者的 BCVA 仍更好（0.34±0.32 LogMAR 与 0.59±0.52 LogMAR；P=0.005）。在我们的研究队列中，19 例患者被诊断为厚脉络膜疾病合并渗出性 MNV，尽管在基线时他们的病历中错误地报告了新生血管性 AMD 的诊断。总之，在年龄较大的患者中，厚脉络膜疾病是渗出性 MNV 的常见原因，误诊率较高。正确的诊断可能很重要，因为这两种疾病在临床特征和预后方面存在差异。
