具有假玻璃膜疣样外观的广泛黄斑萎缩中黄斑新生血管形成的发生率、特征及转归

Incidence, Characteristics, and Outcomes of Macular Neovascularization in Extensive Macular Atrophy with Pseudodrusen-like Appearance.

作者信息

Trinco Andrea, Antropoli Alessio, Bianco Lorenzo, Zaffalon Chiara, Airaldi Matteo, Lanzani Alessandro, Cozzi Mariano, Invernizzi Alessandro, Arrigo Alessandro, Saladino Andrea, Bandello Francesco, Bosello Francesca, Casati Stefano, Salvetti Anna Paola, Parodi Maurizio Battaglia, Staurenghi Giovanni, Romano Francesco

机构信息

Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan, Italy.

Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.

出版信息

Retina. 2025 Apr 30;45(9):1689-700. doi: 10.1097/IAE.0000000000004506.

PURPOSE

To report the incidence, features, and clinical outcomes of macular neovascularization (MNV) in a large Italian cohort of patients with extensive macular atrophy with pseudodrusen-like appearance (EMAP).

METHODS

Retrospective, longitudinal study including 79 EMAP patients (158 eyes) with ≥6 months of follow-up at three retina clinics. Medical records and imaging were reviewed for demographic and clinical data, including age, best-corrected visual acuity (BCVA), MNV features, and retinal pigment epithelium (RPE) atrophy size, measured by short-wavelength autofluorescence and refined with near-infrared and OCT imaging. Main outcomes included cumulative MNV incidence, MNV risk factors, and BCVA and RPE atrophy changes in eyes with and without MNV.

RESULTS

Over a mean follow-up of 40.4 months, MNV developed in 14 eyes (10 patients), with a 4-year cumulative incidence of 15.2%. Most MNVs were type 2 (86%) and subfoveal (64%). Cox regression identified younger age, fellow eye involvement, smaller RPE atrophy size, and greater central subfield thickness (all p<0.01) as significant risk factors for MNV. While eyes with MNV had lower baseline BCVA (58.4 vs. 71.4 letters, approximately 20/63 vs. 20/40 Snellen; p=0.005), BCVA decline over time was similar between the two groups (-3.9 vs. -4.1 letters/year, p=0.69). However, RPE atrophy progressed faster in MNV eyes (3.4 vs. 2.8 mm 2 /year, p=0.02).

CONCLUSIONS

In this EMAP cohort, MNV had a cumulative incidence of 15.2% at 4 years. Although BCVA outcomes were comparable, MNV was associated with faster atrophy progression, potentially due to a more aggressive disease phenotype or fibro-atrophic changes.

目的

报告意大利一个大型广泛黄斑萎缩伴假性玻璃膜疣样外观（EMAP）患者队列中黄斑新生血管（MNV）的发病率、特征及临床结局。

方法

一项回顾性纵向研究，纳入79例EMAP患者（158只眼），在三家视网膜诊所进行了至少6个月的随访。查阅病历和影像资料，获取人口统计学和临床数据，包括年龄、最佳矫正视力（BCVA）、MNV特征以及通过短波自发荧光测量并用近红外和光学相干断层扫描（OCT）成像细化的视网膜色素上皮（RPE）萎缩大小。主要结局包括MNV的累积发病率、MNV的危险因素以及有和无MNV的眼中BCVA和RPE萎缩的变化。

结果

在平均40.4个月的随访期间，14只眼（10例患者）发生了MNV，4年累积发病率为15.2%。大多数MNV为2型（86%）且位于黄斑中心凹下（64%）。Cox回归分析确定年龄较小、对侧眼受累、RPE萎缩面积较小以及中心子野厚度较大（均p<0.01）是MNV的显著危险因素。虽然发生MNV的眼基线BCVA较低（58.4对71.4字母，约20/63对20/40 Snellen视力；p=0.005），但两组间BCVA随时间的下降相似（-3.9对-4.1字母/年，p=0.69）。然而，MNV眼的RPE萎缩进展更快（3.4对2.8 mm²/年，p=0.02）。