Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Eye (Lond). 2023 Aug;37(11):2281-2288. doi: 10.1038/s41433-022-02332-8. Epub 2023 Jan 9.
BACKGROUND/AIMS: To demonstrate two distinct pathways to geographic atrophy (GA) that originate from soft drusen/ pigment epithelial detachments (PEDs) and subretinal drusenoid deposits (SDDs), respectively, and are characterized by their final quantitative autofluorescence (qAF) levels.
23 eyes of 18 patients with GA underwent spectral-domain optical coherence tomography (SD-OCT) and qAF imaging on the qAF-ready Heidelberg Spectralis. 52 GA Regions-of-interest (ROIs), or clusters of adjacent lesions, were selected, and the ROIs were divided into groups by the dominant iAMD precursors on prior serial tracked SD-OCT scans. Mean qAF values and structural SD-OCT findings of groups were compared.
Group 1 lesions (soft drusen/PED precursors, 18/52) were isolated, with lower mean qAF (35.88 ± 12.75 units); group 3 lesions (SDD precursors, 12/52) were multilobular, with significantly higher mean qAF (71.62 ± 12.12 units, p < 0.05). Group 2 lesions, (mixed precursors, 22/52) had intermediate mean qAF (58.13 ± 67.92 units). Significantly greater prevalence of split RPE/ Bruch's membrane complex in SDD-associated GA, suggesting basal laminar deposit (BLamD), than in drusen-associated lesions was the major structural difference.
Quantitative autofluorescence (qAF) of GA lesions may reflect two distinct pathogenic pathways and structural outcomes, originating from soft drusen/PED and subretinal drusenoid deposits (SDDs), with the final qAF values lower or higher, respectively. Basal laminar deposit specifically in and adjacent to SDD-associated lesions may account for their greater autofluorescence. The potential importance of this paradigm is that it could direct, simplify and facilitate research on geographic atrophy by dividing the disease into two components that may be studied separately.
背景/目的：展示两种不同的途径导致地图状萎缩（GA），分别起源于软性玻璃膜疣/色素上皮脱离（PED）和视网膜下类玻璃膜疣沉积物（SDD），并以其最终的定量自发荧光（qAF）水平为特征。
18 名患者的 23 只眼进行了光谱域光学相干断层扫描（SD-OCT）和 qAF 成像，这些患者均在 qAF 准备好的海德堡 Spectralis 上进行。选择 52 个 GA 区域（ROI），或相邻病变的簇，根据先前连续跟踪的 SD-OCT 扫描中主要的 iAMD 前体，将 ROI 分为不同的组。比较各组的平均 qAF 值和结构 SD-OCT 发现。
第 1 组病变（软性玻璃膜疣/PED 前体，18/52）为孤立病变，平均 qAF 较低（35.88±12.75 单位）；第 3 组病变（SDD 前体，12/52）为多叶病变，平均 qAF 显著较高（71.62±12.12 单位，p<0.05）。第 2 组病变（混合前体，22/52）平均 qAF 居中（58.13±67.92 单位）。与玻璃膜疣相关病变相比，SDD 相关 GA 中 RPE/布鲁赫膜复合体分裂的明显更高患病率，提示基底膜层沉积（BLamD），是主要的结构差异。
GA 病变的定量自发荧光（qAF）可能反映两种不同的发病途径和结构结局，分别起源于软性玻璃膜疣/PED 和视网膜下类玻璃膜疣沉积物（SDD），最终 qAF 值较低或较高。基底膜层沉积物特别在 SDD 相关病变中及其周围，可能是其更高的自发荧光的原因。这种范式的潜在重要性在于，它可以通过将疾病分为两个可能单独研究的部分，指导、简化和促进地图状萎缩的研究。
