高度反光焦点在中老年相关性黄斑变性中的分布：空间丰度及其对视网膜形态的影响。

Hyper-Reflective Foci in Intermediate Age-Related Macular Degeneration: Spatial Abundance and Impact on Retinal Morphology.

机构信息

Department of Ophthalmology, University Hospital Bonn, Germany.

Grade Reading Center, University of Bonn, Germany.

出版信息

Invest Ophthalmol Vis Sci. 2023 Jan 3;64(1):20. doi: 10.1167/iovs.64.1.20.

DOI:10.1167/iovs.64.1.20

PMID:36705929

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9896840/

Abstract

PURPOSE

The purpose of this study was to analyze spatially resolved structural changes at retinal locations in presence (+) or absence (-) of hyper-reflective foci (HRF) in eyes with subretinal pigment epithelium (RPE) drusen in intermediate age-related macular degeneration (iAMD).

METHODS

Patients with IAMD (n = 40; mean age = 69.7 ± 9.2 [SD] years) and healthy controls (n = 27; 64.2 ± 9.0) underwent spectral-domain optical-coherence-tomography imaging and fundus-controlled perimetry testing. After reviewing retinal layer segmentation, presence of HRF was annotated and retinal layer thicknesses (RLTs) extracted using ImageJ. Localized RLTs were compared between +HRF and -HRF positions. Univariate mixed linear models were used to investigate associations among RLT, HRF presence, and HRF size.

RESULTS

In iAMD eyes, a mean of 11.1 ± 12.5 HRF were detected with a peak abundance at 0.5 to 1.5 mm eccentricity to the fovea. At +HRF positions, outer nuclear layer (ONL; P = 0.0013, average difference = -12.4 µm) and retinal pigment epithelium drusen complex (RPEDC; P < 0.0001, +45.6 µm) thicknesses differed significantly compared to -HRF positions, even after correcting for accompanying drusen-related RPEDC layer thickening (P = 0.01). Mixed linear models revealed a significant association between increasing HRF area and decreasing ONL (association score = -0.17, P < 0.0001; 95% confidence interval [CI] = -0.22 to -0.11), and inner photoreceptor segments (IS) layer thicknesses (-0.08, P = 0.005; 95% CI = -0.14 to -0.03). Spearman rank correlation analysis yielded a significant correlation between total HRF area and mesopic (P = 0.015), but not scotopic (P = 0.305) retinal sensitivity losses.

CONCLUSIONS

Descriptive analysis of this study demonstrated a predominant distribution of HRF at a foveal eccentricity of 0.5 to 1.5 mm, whereas further refined topographic analysis revealed a significant ONL layer thinning in presence of HRF even after correction for sub-RPE drusen presence compared to lesions in absence of HRF. Longitudinal studies are further needed to analyze the prognostic impact as well as the role of HRF presence in the context of iAMD.

摘要

目的

本研究旨在分析中间型年龄相关性黄斑变性（iAMD）患者中存在（+）或不存在（-）视网膜色素上皮（RPE）下玻璃膜疣（HRF）的视网膜位置的空间分辨结构变化。

方法

患有 iAMD（n = 40；平均年龄 = 69.7 ± 9.2 [SD] 岁）和健康对照组（n = 27；64.2 ± 9.0）的患者接受了光谱域光学相干断层扫描成像和眼底控制的视野检查。在回顾视网膜层分割后，注释 HRF 的存在并使用 ImageJ 提取视网膜层厚度（RLT）。比较 +HRF 和 -HRF 位置之间的局部 RLT。使用单变量混合线性模型研究 RLT、HRF 存在和 HRF 大小之间的关联。

结果

在 iAMD 眼中，平均检测到 11.1 ± 12.5 个 HRF，在距黄斑中心凹 0.5 至 1.5 毫米的偏心处达到峰值丰度。在 +HRF 位置，与 -HRF 位置相比，外核层（ONL；P = 0.0013，平均差异=-12.4 µm）和视网膜色素上皮玻璃膜疣复合物（RPEDC；P < 0.0001，+45.6 µm）厚度差异显著，即使校正了伴随的 RPE 下玻璃膜疣相关的 RPEDC 层增厚（P = 0.01）。混合线性模型显示 HRF 面积增加与 ONL 减少（关联得分=-0.17，P < 0.0001；95%置信区间 [CI] = -0.22 至 -0.11）和内感光细胞节（IS）层厚度减少（-0.08，P = 0.005；95% CI = -0.14 至 -0.03）之间存在显著关联。Spearman 秩相关分析显示，总 HRF 面积与中光（P = 0.015），而不是暗光（P = 0.305）视网膜敏感性损失之间存在显著相关性。

结论

本研究的描述性分析表明 HRF 主要分布在距黄斑中心凹 0.5 至 1.5 毫米的偏心处，而进一步的精细地形分析显示，即使校正了 RPE 下玻璃膜疣的存在，与无 HRF 的病变相比，存在 HRF 时的 ONL 层变薄更显著。需要进一步进行纵向研究，以分析 HRF 存在的预后影响以及在 iAMD 中的作用。