Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA.
Exp Eye Res. 2024 Nov;248:110117. doi: 10.1016/j.exer.2024.110117. Epub 2024 Oct 3.
In age-related macular degeneration (AMD), large choroidal hypertransmission defects (hyperTDs) are identified on en face optical coherence tomography (OCT) images as bright lesions measuring at least 250 μm in greatest linear dimension (GLD). These choroidal hyperTDs arise from focal attenuation or loss of the retinal pigment epithelium (RPE). We previously reported that once large hyperTDs formed, they were likely to persist compared with smaller lesions that were more likely to be transient. Due to their relative persistence, these large persistent choroidal hyperTDs are a point-of-no-return in the progression of intermediate AMD to the late stage of atrophic AMD. Moreover, the onset of these large choroidal hyperTDs can serve as a clinical trial endpoint when studying therapies that might slow disease progression from intermediate AMD to late atrophic AMD. To confirm the persistence of these large choroidal hyperTDs, we studied an independent dataset of AMD eyes enrolled in an ongoing prospective swept-source OCT (SS-OCT) natural history study to determine their overall persistence. We identified a total of 202 eyes with large choroidal hyperTDs containing 1725 hyperTDs followed for an average of 46.6 months. Of the 1725 large hyperTDs, we found that 1718 (99.6%) persisted while only 7 hyperTDs (0.4%) were non-persistent. Of the 7 non-persistent large hyperTDs in 6 eyes, their average GLD at baseline was 385 μm. Of the large hyperTDs ranging in size between 250 and 300 μm when first detected, only one was not persistent with a baseline GLD of 283 μm. In 6 of the non-persistent hyperTDs, the loss of a detectable large hyperTD was due to the accumulation of hyperreflective material along the retinal pigment epithelium (RPE) and in the retina over the area where the hyperTD was located. This hyperreflective material is thought to represent the migration and aggregation of RPE cells into this focal region where the choroidal hyperTD arose due to attenuated or lost RPE.
在年龄相关性黄斑变性 (AMD) 中，在面像光学相干断层扫描 (OCT) 图像上可以识别到大脉络膜高透过性缺陷 (hyperTD)，这些缺陷表现为至少 250μm 最大线性尺寸 (GLD) 的亮斑。这些脉络膜高 TD 是由于视网膜色素上皮 (RPE) 的局部衰减或丢失引起的。我们之前曾报道，一旦形成大的 hyperTD，它们很可能会持续存在，而较小的病变则更有可能是短暂的。由于它们的相对持久性，这些大的持续性脉络膜高 TD 是从中度 AMD 进展为萎缩性 AMD 晚期的不可逆转点。此外，当研究可能减缓从中度 AMD 到晚期萎缩性 AMD 疾病进展的治疗方法时，这些大脉络膜高 TD 的出现可以作为临床试验终点。为了确认这些大脉络膜高 TD 的持续性，我们研究了一项正在进行的前瞻性扫频源 OCT (SS-OCT) 自然史研究中 AMD 眼的独立数据集，以确定它们的总体持续性。我们总共确定了 202 只眼睛，这些眼睛中有大的脉络膜高 TD，其中包含 1725 个高 TD，平均随访时间为 46.6 个月。在 1725 个大的高 TD 中，我们发现 1718 个 (99.6%) 持续存在，而只有 7 个高 TD (0.4%) 是非持续性的。在 6 只眼睛的 7 个非持续性大高 TD 中，它们的平均基线 GLD 为 385μm。在首次检测到大小在 250 至 300μm 之间的大高 TD 中，只有一个基线 GLD 为 283μm 的高 TD 不持续。在 6 个非持续性高 TD 中，一个大高 TD 的消失是由于沿视网膜色素上皮 (RPE) 和高 TD 所在区域的视网膜积累了高反射物质。这种高反射物质被认为代表了 RPE 细胞向由于 RPE 衰减或丢失而出现的脉络膜高 TD 所在的这个局灶区域的迁移和聚集。
