Klefter Oliver Niels, Hansen Michael Stormly, Lykkebirk Lea, Subhi Yousif, Brittain Jane Maestri, Jensen Mads Radmer, Døhn Uffe Møller, Fana Viktoria, Wiencke Anne Katrine, Heegaard Steffen, Terslev Lene, Hamann Steffen
Department of Ophthalmology (O.N.K., M.S.H., L.L., Y.S., A.K.W., S.H., S.H.), Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine (O.N.K., M.S.H., L.L., A.K.W., S.H., L.T., S.H.), University of Copenhagen, Copenhagen, Denmark.
Department of Ophthalmology (O.N.K., M.S.H., L.L., Y.S., A.K.W., S.H., S.H.), Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine (O.N.K., M.S.H., L.L., A.K.W., S.H., L.T., S.H.), University of Copenhagen, Copenhagen, Denmark.
Am J Ophthalmol. 2025 Mar;271:329-336. doi: 10.1016/j.ajo.2024.12.001. Epub 2024 Dec 6.
To determine if paracentral acute middle maculopathy (PAMM) and peripapillary intraretinal and subretinal fluid (IRF/SRF) could help distinguish between arteritic anterior ischemic optic neuropathy (A-AION) and nonarteritic AION (NA-AION) at an early stage.
Nested prospective cross-sectional diagnostic accuracy study.
This study used single-center optical coherence tomography (OCT) data from 8 patients with A-AION and 24 patients with NA-AION from two prospective cross-sectional studies with consecutive sampling (ClinicalTrials.gov: NCT05248906 and NCT05305079). The diagnosis of A-AION was based on expert interpretation of biochemical markers of inflammation, temporal artery biopsy and positron emission tomography/computed tomography. The diagnosis of NA-AION was made in cases without suspicion or clinical evidence of A-AION and with confirmed neuroophthalmological expert diagnosis. For this substudy patients were also required to have an OCT scan in relation to the diagnosis of AION. Macular OCT scans were graded by two independent, masked graders for the presence of PAMM and for IRF/SRF. The extension of IRF/SRF was assessed using an Early Treatment Diabetic Retinopathy Study (ETDRS) grid.
PAMM was found in 50% of patients with A-AION and in 0% of patients with NA-AION (P = .0019). In the setting of AION, the sensitivity of PAMM for the diagnosis of A-AION was 50% (95% CI: 16%-84%) while the specificity was 100% (95% CI: 86%-100%). Conversely, peripapillary IRF/SRF with extension into the ETDRS grid was observed in 83% of patients with NA-AION but in 0% of patients with A-AION (P = .000047). The sensitivity of central macula-involving IRF/SRF for the diagnosis of NA-AION was 83% (95% CI: 63%-95%), while the specificity was 100% (95% CI: 63%-100%). Combining the two biomarkers, 75% of patients with AION could be classified based on OCT alone.
PAMM appears to be a biomarker of A-AION while extensive peripapillary fluid appears to be a biomarker of NA-AION. Combining OCT biomarkers might allow for early classification of AION and warrants further prospective studies.
确定黄斑中心凹旁急性黄斑病变（PAMM）以及视乳头周围视网膜内和视网膜下液（IRF/SRF）是否有助于在早期区分动脉炎性前部缺血性视神经病变（A-AION）和非动脉炎性前部缺血性视神经病变（NA-AION）。
嵌套式前瞻性横断面诊断准确性研究。
本研究使用了来自两项前瞻性横断面连续抽样研究（ClinicalTrials.gov：NCT05248906和NCT05305079）的单中心光学相干断层扫描（OCT）数据，其中包括8例A-AION患者和24例NA-AION患者。A-AION的诊断基于对炎症生化标志物、颞动脉活检和正电子发射断层扫描/计算机断层扫描的专家解读。NA-AION的诊断是在没有A-AION可疑或临床证据且经确诊的神经眼科专家诊断的病例中做出的。对于本亚研究，患者还需要进行与AION诊断相关的OCT扫描。黄斑OCT扫描由两名独立的、不知情的分级人员对PAMM和IRF/SRF的存在情况进行分级。使用糖尿病视网膜病变早期治疗研究（ETDRS）网格评估IRF/SRF的范围。
PAMM在50%的A-AION患者中被发现，而在NA-AION患者中为0%（P = 0.００１９）。在AION的情况下，PAMM对A-AION诊断的敏感性为50%（95%CI：16%-84%），而特异性为100%（95%CI：86%-100%）。相反，在83%的NA-AION患者中观察到视乳头周围 IRF/SRF延伸至ETDRS网格，但在A-AION患者中为0%（P = 0.００００４７）。累及黄斑中心凹的IRF/SRF对NA-AION诊断的敏感性为83%（95%CI：63%-95%），而特异性为100%（95%CI：63%-100%）。结合这两种生物标志物，75%的AION患者仅根据OCT即可分类。
PAMM似乎是A-AION的生物标志物，而广泛的视乳头周围积液似乎是NA-AION的生物标志物。结合OCT生物标志物可能有助于AION的早期分类，值得进一步进行前瞻性研究。
