Hess Kristina, Park Yu Jeong, Kim Hyun-Ah, Holz Frank G, Charbel Issa Peter, Yoon Young Hee, Tzaridis Simone
Department of Ophthalmology, University of Bonn, Bonn, Germany; National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Ophthalmol Retina. 2023 Feb;7(2):101-110. doi: 10.1016/j.oret.2022.08.004. Epub 2022 Aug 7.
Tamoxifen-induced retinopathy (TR) and macular telangiectasia type 2 (MacTel) share a highly similar retinal phenotype. In this study, we aimed to evaluate differences and similarities that may point toward underlying mechanisms linking both disease entities.
Retrospective, cross sectional study.
Patients diagnosed with MacTel or TR.
Patients underwent multimodal retinal imaging, including color fundus photography, spectral-domain OCT, fundus autofluorescence, fluorescein angiography, and OCT angiography (if available). Age, age of onset, best-corrected visual acuity, and bilaterality of changes were evaluated. Patients' eyes were graded for different morphologic characteristics by 4 experienced graders.
Phenotypical characterization and comparison of frequencies of retinal characteristics of TR and MacTel on multimodal imaging.
Twenty-eight eyes of 14 patients with TR and 118 eyes of 59 patients with MacTel were included. Age, age of onset, and best-corrected visual acuity were similar in both cohorts. All but 1 patient showed bilateral changes. In patients with MacTel, neurodegenerative changes and vascular alterations were equally present, whereas in patients with TR, neurodegenerative changes usually prevailed. Predilection sites within the central retina differed between the 2 diseases: most findings in patients with TR were limited to the foveal center, whereas changes in patients with MacTel were present throughout a slightly larger region ("MacTel area"), with an epicenter temporal to the foveal center. Distinct morphologic features included the distribution of retinal crystals, the size and position of ellipsoid zone breaks, and the presence of hyperreflective changes on OCT images. Focal hyperpigmentation and neovascular membranes were only present in eyes with MacTel.
Macular telangiectasia and TR share a highly similar retinal phenotype, especially in early disease stages. Subtle differences on multimodal retinal images may help distinguish between these 2 disease entities. Our findings indicate the involvement of Müller cells in both diseases, which may explain the observed phenotypic characteristics and similarities.
他莫昔芬诱导的视网膜病变（TR）和2型黄斑毛细血管扩张症（MacTel）具有高度相似的视网膜表型。在本研究中，我们旨在评估可能指向连接这两种疾病实体的潜在机制的差异和相似之处。
回顾性横断面研究。
诊断为MacTel或TR的患者。
患者接受多模式视网膜成像，包括彩色眼底照相、光谱域光学相干断层扫描（OCT）、眼底自发荧光、荧光素血管造影以及OCT血管造影（如有）。评估年龄、发病年龄、最佳矫正视力以及病变的双侧性。由4位经验丰富的分级人员对患者的眼睛进行不同形态学特征分级。
在多模式成像上对TR和MacTel的视网膜特征进行表型特征描述和频率比较。
纳入了14例TR患者的28只眼和59例MacTel患者的118只眼。两个队列的年龄、发病年龄和最佳矫正视力相似。除1例患者外，所有患者均表现为双侧病变。在MacTel患者中，神经退行性改变和血管改变同样存在，而在TR患者中，神经退行性改变通常占主导。两种疾病在视网膜中央的好发部位不同：TR患者的大多数表现局限于黄斑中心凹，而MacTel患者的改变出现在稍大的区域（“MacTel区域”），以黄斑中心凹颞侧为中心。独特的形态学特征包括视网膜晶体的分布、椭圆体带破裂的大小和位置以及OCT图像上的高反射性改变。局灶性色素沉着和新生血管膜仅出现在MacTel患者的眼中。
黄斑毛细血管扩张症和TR具有高度相似的视网膜表型，尤其是在疾病早期阶段。多模式视网膜图像上的细微差异可能有助于区分这两种疾病实体。我们的研究结果表明Müller细胞参与了这两种疾病，这可能解释了观察到的表型特征和相似之处。
