伴有假性玻璃膜疣的广泛黄斑萎缩的视觉预后和临床特征

VISUAL OUTCOMES AND CLINICAL FEATURES OF EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN.

作者信息

de Oliveira Audi Letícia, de Carvalho Ricardo A P, Casella Antônio M, Maniero Lourdes Aiko H, Zett Claudio, Messias André M V, Borges Fabrício T, Cyrino Francyne Veiga R, Garrido Theodomiro, Bastos Thais M A, Costa Maria Inêz C, Orefice Juliana L, Marques João Vítor T, Vianna Raul N G, Cialdini Arnaldo P, Diniz Érika P M, Moreira-Neto Carlos A, Moreira Carlos A, Ávila Marcos P, Pimentel Sérgio, Farah Michel E, Jorge Rodrigo, Lima Luiz H

机构信息

Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

Department of Ophthalmology, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil.

出版信息

Retina. 2025 Oct 1;45(10):1842-1853. doi: 10.1097/IAE.0000000000004534.

DOI:10.1097/IAE.0000000000004534

PMID:40397956

Abstract

PURPOSE

To describe extensive macular atrophy with pseudodrusen using multimodal imaging and analyze factors associated with visual loss.

METHODS

This observational case series retrospectively reviewed the clinical and multimodal imaging (color fundus photography, fluorescein angiography, fundus autofluorescence, and optical coherence tomography) of patients between January and December 2023. The extensive macular atrophy with pseudodrusen diagnosis was based on early-onset macular atrophy, pseudodrusen, and bilateral disease. Univariate and multivariate Tobit regression models identified and ranked imaging findings and risk factors ( P < 0.05) for visual loss.

RESULTS

Seventy-four patients (52.7% women) were diagnosed with extensive macular atrophy with pseudodrusen; 86.5% had a history of rheumatic fever, and nearly 17% had heart valve disease. Mean age at onset was 58.7 years (range, 43-73 years), and the mean best-corrected visual acuity was 20/60 (range, 20/800-20/20). Color fundus photography or fundus autofluorescence identified pseudodrusen in 91.7% and 93.0% of eyes, respectively, and optical coherence tomography did so in all evaluable patients. Fundus autofluorescence revealed a hyperautofluorescent edge around the hypoautofluorescent central lesion in 86.6% of eyes. Optical coherence tomography showed a diffuse pseudodrusen pattern in 88.9%, outer retinal loss/thinning in 80.8%, and macular neovascularization in 9.4% of eyes. Subfoveal choroidal thickness ( P = 0.004), outer retinal loss/thinning ( P < 0.01), and preserved fovea ( P < 0.01) were associated significantly with visual acuity. Visual loss was associated with younger age at diagnosis ( P = 0.04) and coexistence of rheumatic fever and heart valve disease ( P = 0.006).

CONCLUSION

Early diagnosis and treatment of rheumatic fever complications may be related to extensive macular atrophy with pseudodrusen progression and outcomes. Longitudinal studies should characterize the natural history of extensive macular atrophy with pseudodrusen.

摘要

目的

使用多模态成像描述伴有假性玻璃膜疣的广泛黄斑萎缩，并分析与视力丧失相关的因素。

方法

本观察性病例系列回顾性分析了2023年1月至12月期间患者的临床和多模态成像（彩色眼底照相、荧光素血管造影、眼底自发荧光和光学相干断层扫描）。伴有假性玻璃膜疣的广泛黄斑萎缩诊断基于早发性黄斑萎缩、假性玻璃膜疣和双侧病变。单变量和多变量托比特回归模型确定并对视力丧失的影像学表现和危险因素进行排名（P<0.05）。

结果

74例患者（52.7%为女性）被诊断为伴有假性玻璃膜疣的广泛黄斑萎缩；86.5%有风湿热病史，近17%有心脏瓣膜病。发病时的平均年龄为58.7岁（范围43 - 73岁），平均最佳矫正视力为20/60（范围20/800 - 20/20）。彩色眼底照相或眼底自发荧光分别在91.7%和93.0%的眼中发现了假性玻璃膜疣，光学相干断层扫描在所有可评估患者中均发现了假性玻璃膜疣。眼底自发荧光在86.6%的眼中显示低自发荧光中央病变周围有高自发荧光边缘。光学相干断层扫描显示88.9%的眼中有弥漫性假性玻璃膜疣模式，80.8%的眼中有外层视网膜丧失/变薄，9.4%的眼中有黄斑新生血管形成。黄斑中心凹下脉络膜厚度（P = 0.004）、外层视网膜丧失/变薄（P<0.01）和保留的黄斑中心凹（P<0.01）与视力显著相关。视力丧失与诊断时年龄较小（P = 0.04）以及风湿热和心脏瓣膜病并存（P = 0.006）有关。