Bousquet Elodie, Abraham Neda, Estawro Rania, Khadka Simanta, Voichanski Shilo, Mafi Mostafa, Au Adrian, Santina Ahmad, Sadda SriniVas, Sarraf David
Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Ophthalmology, University of Paris Cité, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, France.
Retina. 2024 Dec 1;44(12):2041-2048. doi: 10.1097/IAE.0000000000004233.
To describe and study hyporeflective subretinal pigment epithelium (RPE) spaces in large drusen and drusenoid pigment epithelial detachment before collapse.
Retrospective longitudinal study enrolled patients with large and very large drusen caused by intermediate age-related macular degeneration. The following optical coherence tomography parameters were assessed: drusen size (maximum width and height), optical coherence tomography biomarkers of RPE atrophy, presence of intraretinal and subretinal fluid, acquired vitelliform lesion, and sub-RPE regions of hyporeflectivity within the pigment epithelial detachment compartment.
Of the 50 eyes from 41 patients (mean age 77.1 ± 9 years, 78% women) with large and very large drusen, 16 eyes progressed to collapse. Eyes with sub-RPE hyporeflective spaces (n = 8 eyes, 50%) were associated with greater drusen width and height than those without sub-RPE hyporeflective spaces. At the collapse visit, eyes with sub-RPE hyporeflective spaces displayed poorer visual acuity and greater incomplete RPE and outer retinal atrophy and complete RPE and outer retinal atrophy length than eyes without sub-RPE hyporeflective spaces ( P = 0.004 and P = 0.04, respectively).
Sub-RPE hyporeflective spaces are a novel optical coherence tomography finding of large and very large drusen that collapse to atrophy. Progressive RPE dysfunction and failure may lead to reduced drusenoid material formation and progressive degenerative hydration of the large drusen before collapse, but this awaits confirmation with histopathological analysis.
描述并研究大玻璃膜疣及类玻璃膜疣性色素上皮脱离塌陷前的低反射性视网膜色素上皮（RPE）下间隙。
一项回顾性纵向研究纳入了由中度年龄相关性黄斑变性导致大玻璃膜疣和非常大玻璃膜疣的患者。评估了以下光学相干断层扫描参数：玻璃膜疣大小（最大宽度和高度）、RPE萎缩的光学相干断层扫描生物标志物、视网膜内和视网膜下液的存在、获得性卵黄样病变以及色素上皮脱离区内RPE下低反射区域。
在41例患者（平均年龄77.1±9岁，78%为女性）的50只患有大玻璃膜疣和非常大玻璃膜疣的眼中，16只眼进展为塌陷。存在RPE下低反射间隙的眼（n = 8只眼，50%）与不存在RPE下低反射间隙的眼相比，玻璃膜疣宽度和高度更大。在塌陷就诊时，存在RPE下低反射间隙的眼与不存在RPE下低反射间隙的眼相比，视力更差，RPE和外层视网膜不完全萎缩以及RPE和外层视网膜完全萎缩的长度更长（分别为P = 0.004和P = 0.04）。
RPE下低反射间隙是大玻璃膜疣和非常大玻璃膜疣塌陷至萎缩的一种新型光学相干断层扫描表现。进行性RPE功能障碍和衰竭可能导致类玻璃膜疣物质形成减少以及大玻璃膜疣在塌陷前进行性退行性水化，但这有待组织病理学分析证实。
