特发性脉络膜厚血管病变进展为 1 型动脉瘤样脉络膜新生血管或息肉样脉络膜血管病变。
Progression of Pachychoroid Neovasculopathy into Aneurysmal Type 1 Choroidal Neovascularization or Polypoidal Choroidal Vasculopathy.
机构信息
Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany.
Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany.
出版信息
Ophthalmol Retina. 2022 Sep;6(9):807-813. doi: 10.1016/j.oret.2022.04.004. Epub 2022 Apr 7.
PURPOSE
To describe the progression of pachychoroid neovasculopathy (PNV) into pachychoroid aneurysmal type 1 choroidal neovascularization (PAT1)/polypoidal choroidal vasculopathy (PCV).
DESIGN
Retrospective longitudinal cohort study.
SUBJECTS
Patients diagnosed with PNV with a follow-up of ≥2 years.
METHODS
Multimodal imaging, including OCT and fluorescein and indocyanine green angiography, was reviewed for the presence of choroidal neovascularization (CNV), aneurysms within/at the margins of the CNV, and subfoveal choroidal thickness (SFCT).
MAIN OUTCOME MEASURES
Rate of PNV to PAT1/PCV conversion and risk factors thereof.
RESULTS
In total, 37 eyes of 32 patients with PNV with a mean follow-up of 3.3 ± 1.1 years (range, 2.0-5.2) were included in the study. At PNV diagnosis, the mean age was 59.7 ± 8.7 years (range, 38.5-78.0 years) and mean SFCT was 357 ± 92 μm (185-589). During the follow-up, 5 (13.5%) eyes developed aneurysms after a mean 3.4 ± 0.8 years (2.3-4.2), defining PAT1/PCV. The risk of PAT1/PCV conversion was 7.4% at year 3, 13.6% at year 4, and 30.7% at year 5. A mean of 5.2 ± 4.0 to 7.9 ± 3.6 intravitreal anti-VEGF injections were given per year, resulting in a significant reduction of SFCT to 317 ± 104 μm (122-589) (P = 0.0007). The age at diagnosis of PNV was significantly lower in eyes that later went on to develop PAT1/PCV (54.0 ± 5.6 [45.9-60.5] vs. 61.2 ± 8.4 [38.5-78.0] years; P = 0.025). At the end of the follow-up, SFCT had on average decreased by -14.0% ± 17.6% (-55.9% to 23.1%) in the PNV group, whereas it had increased by mean 6.9% ± 4.4% (0.00%-10.8%) in the PAT1/PCV conversion group (P = 0.0025).
CONCLUSIONS
PNV can develop aneurysms within its type 1 CNV, defining the conversion to PAT1/PCV. In this study, the conversion to PAT1/PCV was seen in 13.5% of eyes, resulting in Kaplan-Meier estimates of risk for conversion of 7.4% at year 3, 13.6% at year 4, and 30.7% at year 5. Younger age at diagnosis of PNV and sustained choroidal thickening despite anti-VEGF therapy might be risk factors for PNV to progress into PAT1/PCV.
目的
描述厚脉络膜新生血管（PNV）向厚脉络膜动脉瘤 1 型脉络膜新生血管（PAT1）/息肉样脉络膜血管病变（PCV）的进展过程。
设计
回顾性纵向队列研究。
受试者
随访时间≥2 年的 PNV 患者。
方法
回顾性分析多模态成像资料，包括 OCT 和荧光素及吲哚菁绿血管造影，以评估脉络膜新生血管（CNV）、CNV 内/边缘的动脉瘤以及中心凹下脉络膜厚度（SFCT）的存在情况。
主要观察指标
PNV 向 PAT1/PCV 转化的发生率及其相关危险因素。
结果
共纳入 32 例 37 只眼的 PNV 患者，平均随访时间为 3.3±1.1 年（范围，2.0-5.2）。PNV 诊断时，患者平均年龄为 59.7±8.7 岁（范围，38.5-78.0 岁），平均 SFCT 为 357±92μm（185-589）。在随访期间，5 只眼（13.5%）在平均 3.4±0.8 年后（2.3-4.2）出现了动脉瘤，从而确定为 PAT1/PCV。第 3 年、第 4 年和第 5 年的 PAT1/PCV 转化率分别为 7.4%、13.6%和 30.7%。每年平均需给予 5.2±4.0 至 7.9±3.6 次玻璃体内抗 VEGF 注射，从而使 SFCT 显著降低至 317±104μm（122-589）（P=0.0007）。进展为 PAT1/PCV 的眼在 PNV 诊断时的年龄明显更低（54.0±5.6[45.9-60.5]岁 vs. 61.2±8.4[38.5-78.0]岁；P=0.025）。在随访结束时，PNV 组 SFCT 平均下降了-14.0%±17.6%（-55.9%至 23.1%），而 PAT1/PCV 转化组 SFCT 平均增加了 6.9%±4.4%（0.00%-10.8%）（P=0.0025）。
结论
PNV 可在其 1 型 CNV 内发展出动脉瘤，从而确定向 PAT1/PCV 的转化。在本研究中，13.5%的眼发生了 PAT1/PCV 转化，导致 3 年、4 年和 5 年的转化率分别为 7.4%、13.6%和 30.7%。PNV 诊断时年龄较小以及尽管接受抗 VEGF 治疗仍持续的脉络膜增厚可能是 PNV 进展为 PAT1/PCV 的危险因素。
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