Olivieri Chiara, Fai Antonio, Bhutto Imran A, McLeod D Scott, Neri Giovanni, Reibaldi Michele, Edwards Malia M, Borrelli Enrico
Department of Surgical Sciences, University of Turin, Turin, Italy.
Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy.
Invest Ophthalmol Vis Sci. 2025 Aug 1;66(11):69. doi: 10.1167/iovs.66.11.69.
The purpose of this study was to investigate retinal vascular changes in geographic atrophy (GA) secondary to age-related macular degeneration (AMD) using swept-source optical coherence tomography angiography (SS-OCTA), and to correlate imaging findings with histology.
Sixty subjects were enrolled: 20 with GA, 20 with intermediate AMD, and 20 healthy controls. SS-OCTA imaging was used to quantify retinal perfusion density (PD) and vessel length density (VLD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and full retina. A topographical analysis distinguished regions with and without retinal pigment epithelium (RPE) atrophy in GA eyes. Additionally, flat-mount immunohistochemistry was performed on a donor eye with GA to assess retinal vasculature. Main outcome measures included PD and VLD across SCP, DCP, and full retina, in regions with and without RPE atrophy.
Retinal PD and VLD were significantly reduced in GA eyes compared with intermediate AMD eyes, particularly in the DCP. Topographical analysis revealed more pronounced vascular impairment in areas with RPE atrophy, whereas regions without RPE atrophy in GA eyes exhibited perfusion comparable to intermediate AMD and healthy controls. Histological analysis confirmed a substantial reduction in vascular density within atrophic regions.
Retinal vascular changes in GA predominantly occur within regions of RPE atrophy. The preservation of perfusion in regions without RPE atrophy suggests that vascular impairment is localized. These findings underscore the importance of regional analysis and histopathologic correlation in understanding vascular remodeling in GA. Future longitudinal OCTA studies are warranted to clarify the temporal progression of these vascular alterations in relation to RPE atrophy.
本研究旨在使用扫频光学相干断层扫描血管造影（SS-OCTA）研究年龄相关性黄斑变性（AMD）继发的地图样萎缩（GA）中的视网膜血管变化，并将影像学结果与组织学进行关联。
招募了60名受试者：20名患有GA，20名患有中度AMD，以及20名健康对照者。使用SS-OCTA成像来量化浅表毛细血管丛（SCP）、深层毛细血管丛（DCP）和整个视网膜中的视网膜灌注密度（PD）和血管长度密度（VLD）。地形分析区分了GA眼中有无视网膜色素上皮（RPE）萎缩的区域。此外，对一只患有GA的供体眼进行了平铺免疫组织化学分析以评估视网膜血管系统。主要观察指标包括SCP、DCP和整个视网膜中有无RPE萎缩区域的PD和VLD。
与中度AMD眼相比，GA眼中的视网膜PD和VLD显著降低，尤其是在DCP中。地形分析显示，RPE萎缩区域的血管损伤更为明显，而GA眼中无RPE萎缩的区域表现出与中度AMD和健康对照者相当的灌注。组织学分析证实萎缩区域内的血管密度大幅降低。
GA中的视网膜血管变化主要发生在RPE萎缩区域内。无RPE萎缩区域灌注的保留表明血管损伤是局部性的。这些发现强调了区域分析和组织病理学关联在理解GA中血管重塑方面的重要性。未来有必要进行纵向OCTA研究，以阐明这些血管改变与RPE萎缩相关的时间进程。
