Ophthalmology Center for Imaging and Laser, Paris.
Department of Ophthalmology, Ophtalmopôle Hôpital Cochin, APHP, and University of Paris, Paris, France.
Retina. 2023 Jun 1;43(6):882-887. doi: 10.1097/IAE.0000000000003746.
To report the very long-term visual prognosis of choroidal neovascularization complicating angioid streaks in the antivascular endothelial growth factor era.
Retrospective monocentric study aimed at analyzing patients' demographics, choroidal neovascularization features, angioid streak-associated conditions, and previous and current therapies for choroidal neovascularization. The main outcome measures were the quantitative measurement of central retinal pigment epithelial atrophy enlargement by comparing the ratio of pixels involved on automated infrared images acquired by spectral-domain optical coherence tomography and the changes in best-corrected visual acuity. The secondary outcome measures were the number of intravitreal injections and the changes in central choroidal thickness and central retinal thickness. Subgroup analyzes were performed to compare macular atrophy extent between eyes of patients with or without proven pseudoxanthoma elasticum ("PXE" or "no PXE") and between eyes previously treated or not with photodynamic therapy ("PDT" or "no PDT").
Thirty-three eyes of 23 patients were included. The mean best-corrected visual acuity decreased significantly from 66 ± 19 Early Treatment Diabetic Retinopathy Study letters at the time of the first antivascular endothelial growth factor injection to 52 ± 23 Early Treatment Diabetic Retinopathy Study letters at the end of the follow-up (mean follow-up duration: 109 ± 42 months, range: 47-175 months). The ratio of central retinal pigment epithelial atrophy enlargement was 201%, 110%, 240%, and 111% in the PXE, no PXE, PDT, and no PDT groups, respectively.
Despite the use of antivascular endothelial growth factor agents, the very long-term prognosis appeared relatively poor, especially in patients with PXE. This study also suggests that PDT should be used with caution in the management of choroidal neovascularization in eyes with angioid streaks.
报告抗血管内皮生长因子时代并发格子状脉络膜视网膜病变的脉络膜新生血管的极长期视力预后。
回顾性单中心研究旨在分析患者的人口统计学资料、脉络膜新生血管特征、格子状脉络膜视网膜病变相关情况以及脉络膜新生血管的既往和当前治疗方法。主要观察指标为通过比较频域光相干断层扫描获得的自动红外线图像上受累像素的比率和最佳矫正视力的变化来定量测量中心视网膜色素上皮萎缩扩大。次要观察指标为玻璃体内注射次数以及中心脉络膜厚度和中心视网膜厚度的变化。进行亚组分析以比较有或无明确假性黄色瘤弹性组织变性（“PXE”或“无 PXE”）患者的眼的黄斑萎缩程度以及既往是否接受光动力疗法（“PDT”或“无 PDT”）治疗的眼之间的黄斑萎缩程度。
纳入 23 例患者的 33 只眼。自首次接受抗血管内皮生长因子注射时的最佳矫正视力 66 ± 19 早期糖尿病视网膜病变研究字母下降到随访结束时的 52 ± 23 早期糖尿病视网膜病变研究字母（平均随访时间：109 ± 42 个月，范围：47-175 个月）。在 PXE、无 PXE、PDT 和无 PDT 组中，中心视网膜色素上皮萎缩扩大的比率分别为 201%、110%、240%和 111%。
尽管使用了抗血管内皮生长因子药物，但极长期预后仍然相对较差，尤其是在 PXE 患者中。本研究还表明，在管理伴有格子状脉络膜视网膜病变的脉络膜新生血管时，应谨慎使用 PDT。
