Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.
Singapore Eye Research Institute, Singapore 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856, Singapore.
Sci Rep. 2021 Apr 5;11(1):7495. doi: 10.1038/s41598-021-87083-4.
The natural history and clinical significance of pachydrusen is unclear. This study aims to compare the longitudinal changes of eyes with pachydrusen and soft drusen and progression to exudative macular neovascularisation (MNV). Patients with a diagnosis of MNV in one eye only and the fellow eye was selected as the study eye. Study eyes were required to have pachydrusen or soft drusen on fundus photographs and follow up of at least 2 years or until exudative MNV occurred. Systematic grading was performed at baseline and change in drusen area and onset of exudative MNV recorded over the period of follow up. A total of 75 eyes from 75 patients (29 with pachydrusen and 46 with soft drusen) were included. There was no difference in the rate of progression to exudative MNV in the soft and pachydrusen groups (13.3% versus 24.1%, p = 0.38). Pachydrusen, as compared to soft drusen, was associated with polypoidal choroidal vasculopathy subtype (85.7% versus 16.7%, p < 0.01) and the location of exudation was co-localised with soft drusen but not with pachydrusen. There was a higher rate of increase in soft drusen area compared to pachydrusen area (27.7 ± 31.9%/year versus 8.7 ± 12.4%/year respectively, p < 0.01). We found no difference in the proportion of eyes that developed exudative MNV in this study however characterisation of drusen evolution patterns revealed a strong association with exudative MNV subtype.
盘状硬性渗出的自然病程和临床意义尚不清楚。本研究旨在比较盘状硬性渗出和软性渗出的纵向变化及其向渗出性脉络膜新生血管（MNV）进展的情况。选择仅有一眼患有 MNV 的患者，对其对侧眼作为研究眼。研究眼需在眼底照片上有盘状硬性渗出或软性渗出，并进行至少 2 年的随访或直至出现渗出性 MNV。在基线时进行系统性分级，并记录在随访期间的硬性渗出区变化和渗出性 MNV 的发病情况。共纳入 75 例 75 只眼（29 只眼有盘状硬性渗出，46 只眼有软性渗出）。软性渗出组和盘状硬性渗出组的 MNV 进展率无差异（13.3%比 24.1%，p=0.38）。与软性渗出相比，盘状硬性渗出更易发生息肉样脉络膜血管病变（85.7%比 16.7%，p<0.01），且渗出位置与软性渗出重叠，而不与盘状硬性渗出重叠。软性渗出的面积增加率明显高于盘状硬性渗出（27.7±31.9%/年比 8.7±12.4%/年，p<0.01）。本研究中，渗出性 MNV 的发生率无差异，但硬性渗出和软性渗出的进展模式与渗出性 MNV 亚型密切相关。
