Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.
Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, Paris, France.
Retina. 2024 Oct 1;44(10):1679-1687. doi: 10.1097/IAE.0000000000004194.
To assess differences in choriocapillaris (CC) and macular neovascularization (MNV) optical coherence tomography angiography quantitative parameters between long-term persistently nonexudative MNVs (NE-MNVs) and long-term activated NE-MNVs in age-related macular degeneration.
Age-related macular degeneration patients with treatment-naïve NE-MNVs with >2 years of follow-up and no evidence of exudation within the first 6 months from diagnosis were retrospectively recruited. Two groups were considered according to the occurrence (EX group) or not (NE group) of exudation within the first 2 years of follow-up. Segmentation of the MNV and of the perilesional CC were obtained from enface optical coherence tomography angiography acquisitions at diagnosis and at 6-month follow-up. OCT B-scan images of the MNV were also collected. Fractal ratio was defined as the ratio between MNV fractal dimension (FrD) and CC FrD.
Fifty (50) eyes were included (20 EX group and 30 NE group). EX group showed higher flow deficit density and flow deficit number at the 6-month follow-up. It also showed higher MNV FrD, lower CC FrD, and higher fractal ratio at the 6-month follow-up. The fractal ratio significantly increased at 6-month acquisitions in the EX group, showing an area under the ROC curves of 0.887 (95% CI 0.869-0.922).
Fractal ratio at 6 months can predict exudation risk of MNV within 2 years from diagnosis. This suggests increased structural complexity of the NE-MNV accompanied by progressive capillary rarefaction of the perilesional CC as a key driving factor for the development of exudation in NE-MNV.
评估长期非渗出性脉络膜新生血管（NE-MNV）和年龄相关性黄斑变性中长期激活的 NE-MNV 之间脉络膜毛细血管（CC）和黄斑新生血管（MNV）光学相干断层扫描血管造影定量参数的差异。
回顾性招募了长期未经治疗的 NE-MNV 患者，这些患者在诊断后超过 2 年且在诊断后 6 个月内没有渗出物的证据。根据前 2 年随访期间是否发生（EX 组）或未发生（NE 组）渗出物，将患者分为两组。在诊断时和 6 个月随访时，从平面 OCT 血管造影采集图像中获得 MNV 和病变周围 CC 的分割。还收集了 MNV 的 OCT B 扫描图像。分形比定义为 MNV 分形维数（FrD）与 CC FrD 的比值。
共纳入 50 只眼（20 只 EX 组和 30 只 NE 组）。EX 组在 6 个月随访时显示出更高的血流缺损密度和血流缺损数量。它还显示出更高的 MNV FrD、更低的 CC FrD 和更高的分形比在 6 个月的随访中。EX 组在 6 个月的采集时，分形比显著增加，ROC 曲线下面积为 0.887（95%CI 0.869-0.922）。
6 个月时的分形比可以预测 MNV 在诊断后 2 年内发生渗出的风险。这表明 NE-MNV 的结构复杂性增加，同时病变周围 CC 的毛细血管稀疏程度逐渐增加，这是 NE-MNV 发生渗出的关键驱动因素。
