Arrigo Alessandro, Amato Alessia, Barresi Costanza, Aragona Emanuela, Saladino Andrea, Pina Adelaide, Calcagno Francesca, Bandello Francesco, Battaglia Parodi Maurizio
Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
Ophthalmol Ther. 2022 Feb;11(1):377-386. doi: 10.1007/s40123-021-00443-1. Epub 2021 Dec 19.
Macular neovascularization (MNV) is a common complication of age-related macular degeneration (AMD). Although several biomarkers may help to estimate the risk of MNV onset, neovascular complication is difficult to predict. Previous studies showed that the quantitative assessment of choroidal and choriocapillaris changes is useful for the assessment of atrophy expansion. On the other hand, scant data are available regarding the role of this kind of assessment in the setting of MNV. The aim of the study is to analyze choroidal and choriocapillaris changes occurring before the onset of MNV in patients affected by AMD using quantitative optical coherence tomography (OCT) and OCT angiography (OCTA).
The study was designed as a retrospective case series. Patients affected by AMD, categorized in eyes complicated by MNV and eyes not developing MNV, were retrospectively analyzed for 1 year of follow-up. Choroidal thickness (CT), Sattler layer thickness (SLT) and Haller layer thickness (HLT) were measured on OCT scans. Vessel density (VD) and choriocapillaris (CC) porosity were quantified on OCTA reconstructions. The main outcome measure was the relationship between choroidal and CC parameters, and MNV onset.
We included 50 eyes of 50 AMD patients (28 male; mean age 74 ± 5 years). Over the 1-year follow-up, 15/50 eyes developed MNV (9 type 1; 3 type 2; 3 mixed type 1-2). Mean best-corrected visual acuity (BCVA) was 0.15 ± 0.15 logMAR at baseline, remaining stable in eyes not developing MNV (0.15 ± 0.12 logMAR; p > 0.05), and worsening to 0.38 ± 0.20 logMAR in eyes developing MNV (p < 0.01). VD values were similar between eyes developing MNV and eyes not complicated by MNV at baseline, with significant worsening detected only in MNV eyes. CC porosity was significantly higher in MNV eyes already before the onset of MNV. Furthermore, SLT was significantly lower in eyes developing MNV. The onset of MNV was preceded by a significant increase in intraretinal hyperreflective foci, whereas choroidal hyperreflective foci showed no evident changes.
The degeneration of CC and the SLT thinning represent early an biomarker of MNV onset in AMD.
黄斑新生血管形成（MNV）是年龄相关性黄斑变性（AMD）的常见并发症。尽管有几种生物标志物可能有助于估计MNV发病风险，但新生血管并发症难以预测。既往研究表明，脉络膜和脉络膜毛细血管变化的定量评估有助于萎缩扩展的评估。另一方面，关于这种评估在MNV背景下的作用的数据很少。本研究的目的是使用定量光学相干断层扫描（OCT）和OCT血管造影（OCTA）分析AMD患者MNV发病前发生的脉络膜和脉络膜毛细血管变化。
本研究设计为回顾性病例系列。对患有AMD的患者进行回顾性分析，分为并发MNV的眼和未发生MNV的眼，随访1年。在OCT扫描上测量脉络膜厚度（CT）、萨特勒层厚度（SLT）和哈勒层厚度（HLT）。在OCTA重建上量化血管密度（VD）和脉络膜毛细血管（CC）孔隙率。主要观察指标是脉络膜和CC参数与MNV发病之间的关系。
我们纳入了50例AMD患者的50只眼（男性28例；平均年龄74±5岁）。在1年的随访中，50只眼中有15只发生了MNV（1型9只；2型3只；1-2混合型3只）。基线时平均最佳矫正视力（BCVA）为0.15±0.15 logMAR，未发生MNV的眼保持稳定（0.15±0.12 logMAR；p>0.05），而发生MNV的眼恶化至0.38±0.20 logMAR（p<0.01）。在基线时，发生MNV的眼和未并发MNV的眼之间的VD值相似，仅在MNV眼中检测到显著恶化。在MNV发病前，MNV眼中的CC孔隙率就显著更高。此外，发生MNV的眼中SLT显著更低。MNV发病前视网膜内高反射灶显著增加，而脉络膜高反射灶无明显变化。
CC的退变和SLT变薄是AMD中MNV发病的早期生物标志物。
