Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.
Retina, Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico.
BMJ Open Ophthalmol. 2024 Mar 9;9(1):e001622. doi: 10.1136/bmjophth-2023-001622.
Subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) are associated with systemic vascular diseases that compromise ocular perfusion. We demonstrate that SDDs are associated with decreased ellipsoid zone (EZ) thickness, further evidence of hypoxic damage.
Post hoc analysis of a cross-sectional study. 165 AMD subjects (aged 51-100; 61% women). Spectral-domain optical coherence tomography was obtained in both eyes. Masked readers assigned subjects to three groups: drusen only, SDD+drusen (SDD+D) and SDD only. EZ thickness was measured subfoveally and 2000 µm nasally, temporally, superiorly and inferiorly from the fovea. Univariate testing was performed using two-tailed t-tests with Bonferroni correction.
The mean EZ thickness differences between the SDD+D and drusen-only groups were (in μm) 1.10, 0.67, 1.21, 1.10 and 0.50 at the foveal, nasal, temporal, superior and inferior locations, respectively (p=0.08 inferiorly, otherwise p≤0.01); between the SDD-only and drusen-only groups, the differences were 3.48, 2.48, 2.42, 2.08 and 1.42 (p≤0.0002). Differences in EZ thicknesses across all subjects and between groups were not significantly different based on gender, race or age.
Subjects with SDDs (±drusen) had thinner EZs than those with drusen only, and the inferior EZ was least affected. EZs were thinnest in SDD-only subjects. This thinning gradation is consistent with progressive destruction of highly oxygen-sensitive mitochondria in the EZ from hypoxia. These findings support the reduced ophthalmic perfusion hypothesis for the formation of SDDs secondary to high-risk systemic vasculopathy.
年龄相关性黄斑变性（AMD）中的视网膜下类脂沉积（SDD）与影响眼灌注的系统性血管疾病有关。我们证明 SDD 与椭圆体带（EZ）厚度减少有关，这进一步表明存在缺氧损伤。
对一项横断面研究进行了事后分析。165 名 AMD 患者（年龄 51-100 岁；61%为女性）。对双眼进行了频域光学相干断层扫描。盲法读者将患者分为三组：仅存在玻璃膜疣、存在 SDD+玻璃膜疣（SDD+D）和仅存在 SDD。在黄斑下和距黄斑 2000μm 的鼻侧、颞侧、上侧和下侧测量 EZ 厚度。使用双侧 t 检验和 Bonferroni 校正进行单变量检验。
SDD+D 组和仅存在玻璃膜疣组之间 EZ 厚度的平均差异（μm）分别为：黄斑下 1.10μm、鼻侧 0.67μm、颞侧 1.21μm、上侧 1.10μm 和下侧 0.50μm（下侧 p=0.08，其他部位 p≤0.01）；SDD 组和仅存在玻璃膜疣组之间的差异分别为 3.48μm、2.48μm、2.42μm、2.08μm 和 1.42μm（p≤0.0002）。根据性别、种族或年龄，所有受试者和组间 EZ 厚度的差异均无统计学意义。
存在 SDD（±玻璃膜疣）的患者 EZ 比仅存在玻璃膜疣的患者更薄，且下方 EZ 受影响最小。仅存在 SDD 的患者的 EZ 最薄。这种变薄程度与从缺氧开始 EZ 中高度氧敏感的线粒体逐渐破坏一致。这些发现支持了低氧导致 SDD 形成的眼部灌注减少假说，而 SDD 则继发于高危系统性血管病变。
