Huang Zhen, Deng Kai-Yu, Deng Yu-Meng, Hui Yan-Nian, Song Yan-Ping
The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Department of Ophthalmology, General Hospital of Central Theater Command, Wuhan 430070, Hubei Province, China.
Int J Ophthalmol. 2022 Mar 18;15(3):474-482. doi: 10.18240/ijo.2022.03.16. eCollection 2022.
To evaluate the long-term anatomical and visual outcomes of drusenoid pigment epithelial detachment (D-PED) in intermediate age-related macular degeneration (AMD) eyes treated with 577 nm yellow subthreshold micropulse laser (SML).
In this retrospective study, 21 eyes of 16 patients with D-PED in intermediate AMD were consecutively included and assessed. All the eyes were treated with 577 nm SML in several sessions according to D-PED growth status. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) were assessed at the initial visit and after treatment. Spectral-domain optical coherence tomography (SD-OCT) was performed to evaluate the D-PED lifecycle by volumetric calculations. Regression analysis was used to determine the breakpoint, growth, and collapse rate of the D-PED lesions. The progression to advanced AMD was also documented.
All the eyes were treated with SML for 2.9±1.0 sessions. The mean follow-up period was 25.3±12.6mo. The BCVA was stable from the baseline to final visit. All the eyes were categorized into two groups according to the anatomical changes of the D-PED lesion: the collapse group (=6, 28.6%) and non-collapse group (=15, 71.4%). The change in logMAR BCVA did not differ significantly between the collapse group 0.00 (-0.31, 0.85) and non-collapse group 0.00 (0.00, 0.00; =1). Regression analysis showed that the growth rate was significantly higher in the collapse group (0.090±0.095 mm/mo) than in the non-collapse group (0.025±0.035 mm/mo; <0.001). One eye (4.8%) developed macular neovascularization at 11mo after SML treatment in the non-collapse group. Three eyes (14.3%) developed geographic atrophy (GA) in the collapse group.
Compared to the natural course of D-PED reported by previous studies, our results preliminarily show that SML can alleviate visual loss and possibility of progression to advanced AMD in eyes with D-PED in intermediate AMD. A controlled clinical trial needs to further verify the benefit of the intervention.
评估577nm黄色阈下微脉冲激光（SML）治疗中度年龄相关性黄斑变性（AMD）眼中玻璃膜疣样色素上皮脱离（D-PED）的长期解剖学和视觉效果。
在这项回顾性研究中，连续纳入并评估了16例中度AMD伴D-PED患者的21只眼。根据D-PED的生长状态，所有眼睛分多次接受577nm SML治疗。在初诊时和治疗后评估最小分辨角对数（logMAR）最佳矫正视力（BCVA）。进行光谱域光学相干断层扫描（SD-OCT），通过体积计算评估D-PED的生命周期。采用回归分析确定D-PED病变的断点、生长和消退率。还记录了进展为晚期AMD的情况。
所有眼睛接受SML治疗2.9±1.0次。平均随访期为25.3±12.6个月。从基线到末次随访，BCVA保持稳定。根据D-PED病变的解剖学变化，所有眼睛分为两组：消退组（=6，28.6%）和未消退组（=15，71.4%）。消退组logMAR BCVA变化为0.00（-0.31，0.85），未消退组为0.00（0.00，0.00；=1），两组间差异无统计学意义。回归分析显示，消退组的生长率（0.090±0.095mm/月）显著高于未消退组（0.025±0.035mm/月；<0.001）。未消退组有1只眼（4.8%）在SML治疗后11个月发生黄斑新生血管。消退组有3只眼（14.3%）发生地图样萎缩（GA）。
与既往研究报道的D-PED自然病程相比，我们的结果初步显示，SML可减轻中度AMD伴D-PED患者眼睛的视力丧失，并降低进展为晚期AMD的可能性。需要进行对照临床试验以进一步验证该干预措施的益处。
