Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal.
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
Graefes Arch Clin Exp Ophthalmol. 2021 Sep;259(9):2583-2595. doi: 10.1007/s00417-021-05129-9. Epub 2021 Mar 2.
To identify predictive factors for RPE tear remodelling and its correlation with functional and morphological outcomes.
Retrospective longitudinal study of patients with retinal pigment epithelium (RPE) tears secondary to age-related macular degeneration (AMD). Imaging was performed using spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). RPE layer integrity in the RPE-denuded area was examined with SD-OCT, and variation in the RPE-denuded homogeneous hypofluorescent area was examined with FAF over time for each case (eye). Patients were divided in two groups, according to the presence (Rem) or absence (No Rem) of evidence of RPE tear remodelling. Data were collected at three different time points: at baseline (at diagnosis of exudative AMD), at RPE tear diagnosis, and at the last available follow-up. Using SD-OCT, the following parameters were evaluated: type of CNV, type of PED and its dimensions, presence of subretinal (SRF) or intraretinal (IRF) fluid, central retinal thickness (CRT), presence and location of hyperreflective dots, and dimension and location of RPE tear.
This study included 32 eyes from 31 patients (19 female and 12 male), with RPE tears secondary to AMD. RPE remodelling after tear development was evident in 17 (53.1%) eyes after 7 [1-59] months. Anatomical recovery was associated with a younger age at RPE tear diagnosis (73 ± 7 vs. 81 ± 7 years old, p=0.01), smaller and narrower retinal pigment epithelial detachment (PED) at tear diagnosis (height 369 vs. 602 μm, p=0.02; width 2379 vs. 3378 μm, p=0.04), and the presence of SRF at tear diagnosis (94% vs. 53%, p=0.02). After adjusting for other covariates, a younger age at RPE tear diagnosis maintained significant association with RPE tear remodelling. RPE tear remodelling did not correlate with a better visual outcome at last follow-up (43 ± 22.8 vs. 34 ± 23.8 ETDRS letters, p=0.30). Final VA was directly proportional to VA at tear diagnosis (r= 0.654; p<0.001) and correlated negatively with PED width at tear diagnosis (r = -0.388; p=0.03).
RPE remodelling was evident in half of our sample and was associated with a younger age, smaller and narrower PED at RPE tear diagnosis, and presence of SRF also at tear diagnosis. Nevertheless, this structural recovery did not result in a better functional outcome.
确定预测 RPE 撕裂重塑的因素及其与功能和形态结果的相关性。
对继发于年龄相关性黄斑变性（AMD）的 RPE 撕裂患者进行回顾性纵向研究。使用谱域光相干断层扫描（SD-OCT）和眼底自发荧光（FAF）进行成像。使用 SD-OCT 检查 RPE 脱失区的 RPE 层完整性，并随时间检查每个病例（眼）的 RPE 脱失均匀低荧光区的变化。根据是否存在（Rem）或不存在（No Rem）RPE 撕裂重塑的证据，将患者分为两组。数据在三个不同时间点收集：基线（渗出性 AMD 诊断时）、RPE 撕裂诊断时和最后一次随访时。使用 SD-OCT 评估以下参数：CNV 类型、PED 类型及其尺寸、是否存在视网膜下（SRF）或视网膜内（IRF）液、中央视网膜厚度（CRT）、是否存在和位置高反射点，以及 RPE 撕裂的尺寸和位置。
本研究纳入了 31 例 32 只眼继发于 AMD 的 RPE 撕裂患者。在 7 [1-59] 个月后，17 只（53.1%）眼出现 RPE 撕裂后的重塑。解剖学恢复与 RPE 撕裂诊断时年龄较小（73 ± 7 岁 vs. 81 ± 7 岁，p=0.01）、撕裂诊断时较小和较窄的 RPE 脱离（高度 369 对 602 μm，p=0.02；宽度 2379 对 3378 μm，p=0.04）以及撕裂诊断时存在 SRF 有关（94% vs. 53%，p=0.02）。在调整其他协变量后，RPE 撕裂诊断时年龄较小与 RPE 撕裂重塑仍保持显著相关性。RPE 撕裂重塑与最后一次随访时更好的视力结果无关（43 ± 22.8 对 34 ± 23.8 ETDRS 字母，p=0.30）。最终 VA 与撕裂诊断时的 VA 直接成正比（r=0.654；p<0.001），与撕裂诊断时 PED 宽度呈负相关（r=-0.388；p=0.03）。
在我们的样本中，有一半出现了 RPE 重塑，与 RPE 撕裂诊断时年龄较小、PED 较小且较窄以及撕裂诊断时存在 SRF 有关。然而，这种结构恢复并没有带来更好的功能结果。
