Doheny Eye Institute, University of California at Los Angeles, Los Angeles, CA, USA.
Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Graefes Arch Clin Exp Ophthalmol. 2021 Oct;259(10):2887-2895. doi: 10.1007/s00417-021-05167-3. Epub 2021 Apr 26.
To evaluate the relationship between choriocapillaris (CC), flow deficits (FD), and structural optical coherence tomography (OCT) biomarkers, and the progression of intermediate age-related macular degeneration (iAMD) to complete retinal pigment epithelial and outer retinal atrophy (cRORA) or macular neovascularization (MNV).
Consecutive patients with iAMD were sequentially reviewed to define three equal sized groups: progressed to MNV, progressed to cRORA, or remained stable over 12 months of follow-up. Odds ratios for progression to cRORA and MNV were estimated by logistic regression for intraretinal hyperreflective foci (IHRF), hyporeflective drusen cores (hDC), subretinal drusenoid deposits (SDDs), high central drusen volume, fellow eye with late AMD, and peripheral and central CC FD.
Thirty iAMD eyes from 30 patients were enrolled into each group. The CC FD was greater in the peripheral sectors of the macula of eyes which progressed to cRORA compared to the other two groups (P < 0.0001). The central CC FD was also significantly impaired in eyes that progressed to cRORA or MNV compared to eyes that did not progress (P = 0.001 and P = 0.02, respectively). CC FD in the peripheral macula was significantly and independently associated with the development of cRORA, while CC FD in the center was significantly and independently associated with the development of MNV.
While the CC is diffusely impaired throughout the macula in iAMD eyes that progress to cRORA, it is relatively spared in the more peripheral macula among eyes which progress to MNV. These differential findings may have implications for the pathophysiology of the different late-stage manifestations of AMD.
评估脉络膜毛细血管（CC）、血流缺损（FD）与结构光相干断层扫描（OCT）生物标志物之间的关系，以及从中度年龄相关性黄斑变性（iAMD）进展为完全性视网膜色素上皮和外层视网膜萎缩（cRORA）或黄斑新生血管化（MNV）的关系。
对连续的 iAMD 患者进行回顾性队列研究，以将其分为三组：进展为 MNV 组、进展为 cRORA 组和 12 个月随访期间稳定组。采用逻辑回归分析评估视网膜内高反射灶（IHRF）、低反射性玻璃膜疣核心（hDC）、脉络膜视网膜下硬性渗出（SDD）、高中心玻璃膜疣体积、对侧眼晚期 AMD 以及周边和中心 CC FD 对进展为 cRORA 和 MNV 的比值比。
每个组均纳入了 30 例 iAMD 患者的 30 只眼。与其他两组相比，进展为 cRORA 的眼的周边黄斑区的 CC FD 更高（P < 0.0001）。与未进展的眼相比，进展为 cRORA 或 MNV 的眼的中央 CC FD 也明显受损（P = 0.001 和 P = 0.02）。周边黄斑区的 CC FD 与 cRORA 的发生显著相关，而中央 CC FD 与 MNV 的发生显著相关。
在进展为 cRORA 的 iAMD 眼中，CC 整体弥漫性受损，但在进展为 MNV 的眼中，其周边黄斑区相对未受损。这些差异发现可能对 AMD 不同晚期表现的病理生理学有影响。
