玻璃膜疣内低反射核心：与年龄相关性黄斑变性进展的相关性及其对视敏度的影响。

Hyporeflective Cores within Drusen: Association with Progression of Age-Related Macular Degeneration and Impact on Visual Sensitivity.

机构信息

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia.

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.

出版信息

Ophthalmol Retina. 2022 Apr;6(4):284-290. doi: 10.1016/j.oret.2021.11.004. Epub 2021 Dec 3.

DOI:10.1016/j.oret.2021.11.004

PMID:34871775

Abstract

PURPOSE

To examine the association between hyporeflective cores within drusen (HCD) and disease progression in age-related macular degeneration (AMD) and with visual function.

DESIGN

Longitudinal observational study.

PARTICIPANTS

Two hundred and eighty eyes from 140 participants with bilateral large drusen, without late AMD.

METHODS

Multimodal imaging and microperimetry were performed at baseline and subsequently every 6 months for up to 3 years. Baseline OCT scans were graded for the presence of HCD and used to calculate drusen volume. The total area of the drusenoid lesions containing hyporeflective cores (HCD extent) on color fundus photographs (CFPs) was calculated. CFPs were also graded for the presence of pigmentary abnormalities. The association between HCD extent with progression to late AMD (including OCT signs of atrophy) and visual sensitivity measured using microperimetry at baseline and its rate of change over time was evaluated with and without adjustment for confounders of drusen volume, pigmentary abnormalities, and age.

MAIN OUTCOME MEASURES

Time to develop late AMD and visual sensitivity.

RESULTS

Twenty (7%) eyes from 12 (9%) individuals were found to have HCD at baseline, which was associated with a nonsignificantly increased rate of progression to late AMD (unadjusted P = 0.050). HCD extent was significantly associated with an increased rate of progression to late AMD (unadjusted P = 0.034) and lower visual sensitivity at baseline (unadjusted P < 0.001). However, these associations were no longer significant (P ≥ 0.264 for both) after adjusting for known risk factors for AMD progression. HCD extent was also not associated with a faster rate of visual sensitivity decline before the development of late AMD, with or without adjustment (P ≥ 0.674 for both). Increasing age and larger drusen volume were associated with HCD extent (P ≤ 0.041).

CONCLUSIONS

In a cohort with bilateral large drusen, HCD presence and extent were not independently associated with an increased rate of progression to late AMD over 3 years, nor with lower visual sensitivity or an increased rate of visual sensitivity decline before the development of late AMD, after adjusting for known risk factors for disease progression.

摘要

目的

探讨玻璃膜疣内低反射核心（HCD）与年龄相关性黄斑变性（AMD）疾病进展的相关性，以及与视觉功能的相关性。

设计

纵向观察性研究。

参与者

280 只眼来自 140 名双侧大玻璃膜疣患者，无晚期 AMD。

方法

在基线时以及随后每 6 个月进行多模态成像和微视野检查，最长可达 3 年。在基线时进行 OCT 扫描以评估 HCD 的存在，并计算玻璃膜疣体积。在眼底彩照（CFP）上计算包含低反射核心的玻璃膜疣样病变的总面积（HCD 范围）。还对 CFP 上色素异常的存在进行分级。使用微视野评估 HCD 范围与基线时向晚期 AMD（包括 OCT 萎缩迹象）进展以及随时间变化的视觉敏感性之间的关系，并在调整玻璃膜疣体积、色素异常和年龄的混杂因素前后进行评估。

主要观察指标

发展为晚期 AMD 和视觉敏感性的时间。

结果

在基线时有 20 只眼（7%）来自 12 名（9%）患者被发现存在 HCD，这与向晚期 AMD 进展的速度增加无显著相关性（未调整 P=0.050）。HCD 范围与向晚期 AMD 进展的速度增加显著相关（未调整 P=0.034），且与基线时的视觉敏感性降低显著相关（未调整 P<0.001）。然而，在调整 AMD 进展的已知危险因素后，这些相关性不再具有统计学意义（两者均 P≥0.264）。在发生晚期 AMD 之前，HCD 范围也与视觉敏感性下降的速度增加无关，无论是否进行调整（两者均 P≥0.674）。年龄增加和更大的玻璃膜疣体积与 HCD 范围相关（P≤0.041）。