Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, CA, USA.
Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Eye (Lond). 2021 Nov;35(11):2991-2998. doi: 10.1038/s41433-020-01298-9. Epub 2021 Jan 7.
To evaluate the choriocapillaris (CC) flow deficit (FD) in eyes with stable intermediate age-related macular degeneration (AMD) eyes over 12 months of follow-up.
Thirty four patients with intermediate AMD were prospectively enrolled and evaluated by swept-source optical coherence tomography (SS-OCT) and OCT-angiography (OCTA) using the PLEX-Elite 9000. A 6 × 6 mm foveal-centered scan was used for both modalities and the study eyes were scanned twice to allow subsequent averaging. En face OCTA CC slabs (31-41 µm below the RPE-band) were exported and compensated for signal attenuation. Two compensated CC en-face images were registered and averaged prior to binarization and CC FD computation. The CC FD of the entire 6 × 6 macular region was quantified at baseline and at 12-months. The presence of high-risk features, namely intraretinal hyper-reflective foci (HRF), subretinal drusenoid deposits (SDD), and hyporeflective-core-drusen, were evaluated using SS-OCT volume scans.
Among the 34 eyes, 25 eyes from 25 patients were noted on exam and OCT to remain stable as intermediate AMD at 12-months without the development of late AMD. Eleven eyes had high-risk features at baseline compared to 14 eyes at the end of the follow-up (p = 0.094). The mean ± SD FD% across the whole 6 × 6 macular region at baseline was 19.32 ± 4.64% and significantly increased to 28.62 ± 4.71% at the end of the study (p = 0.001). The CC FD progressed significantly both in non-HR and HR-eyes.
Choriocapillaris flow impairment significantly deteriorated over one year in relatively stable intermediate AMD. This might suggest that underlying progression of CC dysfunction occurs before structural changes appears on OCT and lead to the progression to late-stage AMD.
评估稳定的中期年龄相关性黄斑变性（AMD）眼在 12 个月的随访中脉络膜毛细血管（CC）血流不足（FD）。
前瞻性纳入 34 例中期 AMD 患者，使用扫频源光学相干断层扫描（SS-OCT）和 OCT 血管造影（OCTA）进行评估，使用 PLEX-Elite 9000。两种方式均使用 6×6mm 中心凹扫描，两次扫描以允许后续平均。导出和补偿信号衰减的 31-41μm 下方 RPE 带的 CC 层 OCTA 面。在二值化和 CC FD 计算之前，对两个补偿的 CC 面图像进行注册和平均。在基线和 12 个月时定量评估整个 6×6 黄斑区域的 CC FD。使用 SS-OCT 容积扫描评估存在高风险特征，即视网膜内高反射灶（HRF）、视网膜下类脂沉积（SDD）和低反射核 - 脂沉积。
在 34 只眼中，有 25 只眼（25 名患者）在 12 个月时的检查和 OCT 上仍保持稳定的中期 AMD，没有发展为晚期 AMD。11 只眼在基线时有高风险特征，而在随访结束时有 14 只眼（p=0.094）。整个 6×6 黄斑区域的平均 FD%在基线时为 19.32±4.64%，在研究结束时显著增加到 28.62±4.71%（p=0.001）。非 HR 和 HR 眼的 CC FD 均显著进展。
在相对稳定的中期 AMD 中，脉络膜毛细血管血流功能障碍在一年中显著恶化。这可能表明，在 OCT 上出现结构变化之前，CC 功能障碍的潜在进展已经发生，并导致进展为晚期 AMD。
