Chandra Shruti, Gurudas Sarega, Narayan Akshay, Sivaprasad Sobha
University College London, Institute of Ophthalmology, London, United Kingdom; NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom.
University College London, Institute of Ophthalmology, London, United Kingdom.
Ophthalmol Retina. 2022 Mar;6(3):196-204. doi: 10.1016/j.oret.2021.07.009. Epub 2021 Aug 12.
To study the time course to macular atrophy (MA) and associated risk factors in eyes with acquired vitelliform lesions (AVLs) as they vary between patients and between eyes of an individual.
Single-center, retrospective, observational cohort study.
Consecutive patients registered between January 2009 and January 2014 with first diagnosis of AVL confirmed by multimodal imaging were included. Eyes with baseline MA or choroidal neovascularization were excluded.
Patient demographics were collected. Serial OCT scans and fundus autofluorescence (FAF) scans were graded and analyzed. Turnbull's estimator was used, and time was censored at 5 years. Multivariable Weibull parametric proportional hazard models were used to assess the association of risk factors with MA after adjustment for age and gender. Hazard ratios (HRs) are reported with 95% confidence interval (CI).
Time to the first OCT evidence of MA stratified by presenting visual acuity (VA) and AVL lesion subtypes. Secondary outcome included risk factors for incident MA.
A total of 237 eyes (132 patients) met the inclusion criteria. Incident MA was detected in 52 of 237 eyes (21.9%) by 5 years. Stratified by baseline VA, 40.3% of eyes with VA ≤70 letters developed atrophy within 5 years of first diagnosis in contrast to 10.3% eyes with VA >70 letters (P < 0.001). Based on lesion type only, 12.9% of eyes with vitelliform lesion at baseline developed MA versus 39.8% and 44.2% of eyes with pseudohypopyon or vitelliruptive lesion type, respectively. In adjusted analysis, baseline factors associated with increased risk of MA included VA ≤70 letters (hazard ratio [HR], 5.54; 95% confidence interval [CI], 2.30-13.34), base width (HR, 1.22; 95% CI, 1.16-1.28), maximum height (HR, 2.61; 95% CI, 1.82-3.74), presence of subretinal drusenoid deposits (SDDs) (HR, 2.83; 95% CI, 1.34-5.96), and disrupted external limiting membrane (ELM) (HR, 2.81; 95% CI, 1.34-5.86).
Baseline VA of ≤70 letters (Snellen ≤20/40) and pseudohypopyon or vitelliruptive lesion type attribute the highest risk for MA. Other prognostic indicators for MA include baseline presence of SDD, disrupted ELM, and larger lesion area.
研究获得性卵黄样病变（AVL）患者黄斑萎缩（MA）的病程及相关危险因素，这些因素在不同患者及个体双眼之间存在差异。
单中心、回顾性、观察性队列研究。
纳入2009年1月至2014年1月期间首次诊断为AVL且经多模态成像确诊的连续患者。排除基线存在MA或脉络膜新生血管的眼。
收集患者人口统计学资料。对系列光学相干断层扫描（OCT）和眼底自发荧光（FAF）扫描进行分级和分析。采用Turnbull估计量，并将时间截尾设定为5年。多变量威布尔参数比例风险模型用于评估在调整年龄和性别后危险因素与MA的关联。报告风险比（HR）及95%置信区间（CI）。
首次出现MA的OCT证据的时间，按初始视力（VA）和AVL病变亚型分层。次要观察指标包括MA发生的危险因素。
共有237只眼（132例患者）符合纳入标准。到5年时，237只眼中有52只（21.9%）检测到MA发生。按基线VA分层，初始诊断后5年内，VA≤70字母的眼中40.3%出现萎缩，而VA>70字母的眼中这一比例为10.3%（P<0.001）。仅基于病变类型，基线时为卵黄样病变的眼中12.9%发生MA，而假性前房积脓或卵黄破裂病变类型的眼中这一比例分别为39.8%和44.2%。在调整分析中，与MA风险增加相关的基线因素包括VA≤70字母（风险比[HR]，5.54；95%置信区间[CI]
