School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Invest Ophthalmol Vis Sci. 2023 Dec 1;64(15):38. doi: 10.1167/iovs.64.15.38.
The purpose of this study was to investigate factors associated with drusenoid pigment epithelium detachment (dPED) growth rate, incidence of dPED collapse, and retinal pigment epithelium (RPE) atrophy enlargement rate following dPED collapse and their impact on visual acuity (VA).
This was a retrospective longitudinal study on 44 eyes. Serial spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (AF) imaging were performed. Qualitative features and quantitative dPED-related metrics were assessed. The surface-to-volume ratio (S/V) was computed to evaluate dPED shape irregularity. AF imaging was utilized to measure RPE atrophy area in eyes experiencing dPED collapse. Regression models were used to analyze associations among VA, dPED growth rate, and RPE atrophy enlargement rate. Cox regression was used to identify risk factors for dPED collapse.
Significant correlations were observed between dPED area, surface, and volume (P < 0.05 for all pairs). The dPED metrics were inversely correlated with the S/V. Incidence of dPED collapse was 22 per 100 eye-years over a mean follow-up of 59 ± 41 months. Eyes experiencing collapsed dPED had worse baseline VA (P < 0.001). RPE hypertransmission (hazard ratio [HR] = 3.68, P = 0.004) and hyper-reflective foci (HR = 3.45, P = 0.02) were risk factors for dPED collapse; a higher S/V ratio was protective (HR = 0.78, P = 0.03). A faster rate of RPE atrophy enlargement was associated with a faster rate of dPED volume increase (r = 0.47, P = 0.02) and worse VA over time (P = 0.02).
Risk stratification in patients with dPED can be aided by identifying risk factors for dPED collapse. Identifying factors associated with RPE atrophy enlargement may have implications for treatment decision making.
本研究旨在探讨与玻璃膜疣性色素上皮脱离（dPED）生长速度、dPED 塌陷发生率、dPED 塌陷后色素上皮（RPE）萎缩扩大速度以及它们对视敏度（VA）的影响相关的因素。
这是一项对 44 只眼进行的回顾性纵向研究。对其进行了频域光学相干断层扫描（SD-OCT）和眼底自发荧光（AF）成像的连续检查。评估定性特征和定量 dPED 相关指标。计算表面积与体积比（S/V）以评估 dPED 形态不规则性。在经历 dPED 塌陷的眼中，使用 AF 成像测量 RPE 萎缩面积。使用回归模型分析 VA、dPED 生长速度和 RPE 萎缩扩大速度之间的相关性。使用 Cox 回归识别 dPED 塌陷的危险因素。
dPED 面积、表面和体积之间存在显著相关性（所有对均 P < 0.05）。dPED 指标与 S/V 呈负相关。在平均 59 ± 41 个月的随访中，每 100 只眼年发生 22 次 dPED 塌陷。经历了塌陷性 dPED 的眼睛基线 VA 更差（P < 0.001）。RPE 高透过性（危险比 [HR] = 3.68，P = 0.004）和高反射性焦点（HR = 3.45，P = 0.02）是 dPED 塌陷的危险因素；较高的 S/V 比值具有保护作用（HR = 0.78，P = 0.03）。RPE 萎缩扩大速度较快与 dPED 体积增加较快（r = 0.47，P = 0.02）和随时间推移 VA 恶化（P = 0.02）相关。
通过识别 dPED 塌陷的危险因素，可以为 dPED 患者的风险分层提供帮助。确定与 RPE 萎缩扩大相关的因素可能对治疗决策有影响。
