Goerdt Lukas, Rodriguez Garcia Jose Luis, Künzel Sandrine H, Pfau Kristina, Raming Kristin, Tzaridis Simone, Schmid Matthias, Holz Frank G, Isselmann Ben, Weinhold Leonie, Thiele Sarah
Department of Ophthalmology, University of Bonn, Bonn, Germany.
Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.
Invest Ophthalmol Vis Sci. 2024 Dec 2;65(14):36. doi: 10.1167/iovs.65.14.36.
The relative ellipsoid zone reflectivity (rEZR) is an innovative biomarker for photoreceptor alterations and showed association with disease staging in macular telangiectasia type 2 (MacTel). However, its prognostic relevance for the ellipsoid zone (EZ) loss is unclear.
Longitudinal spectral-domain optical coherence tomography (SD-OCT) imaging of patients with MacTel from an observational natural history study was used for en face determination of manifest EZ loss. The rEZR was assessed globally (mean rEZR/SD-OCT volume scan) and topographically (spatially refined). Logistic and linear-mixed effect models were used to investigate the rEZR's association with EZ loss onset and the (square-root transformed) progression rate of existing EZ loss.
A total of 97 eyes of 70 patients (39 women, mean age = 60.3 ± 8.9 years) were included and reviewed in a median observational period of 28.7 months (range = 20.3-49.9 months). Whereas 65 eyes of 44 patients showed manifest EZ loss (mean ± SD area = 0.44 ± 0.57 mm2) at baseline, 14 eyes of 14 patients developed EZ loss over time. Significant associations of the rEZR were only found in the topographical analyses indicated by lower rEZR values and a higher risk for EZ loss onset (odds ratio [OR] = 0.34, 95% confidence interval [CI] = 0.29 to 0.39, P < 0.001) as well as a faster EZ loss progression (coefficient estimate = -0.002, 95% CI = -0.0046 to 0.0001, P = 0.038).
This study demonstrates the prognostic relevance of spatially refined rEZR changes before and beyond already existing EZ loss for both its onset and progression over time in MacTel. Further analyses of the rEZR are warranted to achieve both a more tailored patient selection and a novel end point identification for clinical trials in MacTel.
相对椭圆体区反射率（rEZR）是一种用于检测光感受器改变的创新生物标志物，并且已显示其与2型黄斑毛细血管扩张症（MacTel）的疾病分期相关。然而，其对于椭圆体区（EZ）缺失的预后相关性尚不清楚。
来自一项观察性自然病史研究的MacTel患者的纵向光谱域光学相干断层扫描（SD-OCT）成像用于对明显的EZ缺失进行表面观察测定。rEZR通过全局（平均rEZR/SD-OCT体积扫描）和局部（空间细化）方式进行评估。使用逻辑和线性混合效应模型来研究rEZR与EZ缺失发生以及现有EZ缺失的（平方根转换后的）进展速率之间的关联。
共纳入70例患者的97只眼（39名女性，平均年龄 = 60.3±8.9岁），中位观察期为28.7个月（范围 = 20.3 - 49.9个月）。在基线时，44例患者的65只眼显示明显的EZ缺失（平均±标准差面积 = 0.44±0.57mm²），14例患者的14只眼随时间出现EZ缺失。仅在局部分析中发现rEZR存在显著关联，表现为rEZR值较低且EZ缺失发生风险较高（优势比[OR] = 0.34，95%置信区间[CI] = 0.29至0.39，P < 0.001）以及EZ缺失进展更快（系数估计 = -0.002，95%CI = -0.0046至0.0001，P = 0.038）。
本研究证明了在MacTel中，空间细化的rEZR变化在已存在的EZ缺失之前及之后对于其发生和随时间进展的预后相关性。有必要对rEZR进行进一步分析，以实现更精准的患者选择和为MacTel临床试验确定新的终点。
