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光学相干层析成像预测非新生血管性萎缩性年龄相关性黄斑变性的风险

Sleiman, K., Veerappan, M., Winter, K.P., et al.

期刊名称:Ophthalmology

卷期:2017年第124卷第12期

摘要

摘要:目的:在彩色摄影(CP)显示地理萎缩(GA)之前,光谱域光学相干断层扫描(SD OCT)具有特定的特征。我们的旨在建立建立基于华侨城基于SD5年新的发病风险评估模型,并在CP的中心地区。设计:前瞻性纵向研究。研究对象:年龄相关性眼病研究2辅助SD OCT研究中的年龄相关性黄斑变性(AMD),双侧大玻璃膜疣或非中央型GA,至少1只眼无先天性疾病(n = 317)患者。方法:每位受试者1只眼,分别在基线时,7年以上通过标准化分级和半自动分割获取定性和定量SD OCT变量,提取每年预后并进行分析以适合多元逻辑回归模型,并建立风险计算器。主要观察指标:新发现的CP-可见遗传算法和中心遗传算法。结果:随访中位数为4.0年,292AMD眼(无基线进展期疾病)具有完整的结果资料,46例(15.8%)发展为中心性GA。基线CP无任何GA265只眼中,70只眼(26.4%)发展为CP可见的GA。最终的多变量模型进行了年龄调整。在GA模型中,独立预测的SD OCT因子(P <0.001-0.03)为:高反射性病灶和视网膜色素上皮层(RPE)萎缩或缺失,其次是无视网膜下类玻璃体沉积时的脉络膜厚度,感光细胞外段缺失,RPE玻璃膜疣复合体积和RPE玻璃膜疣复合体异常变薄量。对于中心性GA,各因素(P <0.001)为RPE玻璃膜疣复合体异常变薄体积,视网膜内液或囊样间隙,高反射病灶和RPE层萎缩或缺失。建立计算1-5年后CP可见,新发GA和中心GA概率的模型。结论:对于大玻璃体疣AMD而无晚期疾病患者,我们根据年龄和SD OCT分割,玻璃膜疣特征和5年以上进展为CP可见GA的视网膜病理学建立了一种新的风险评估模型 。这个计算器可以简化SD OCT分级,并且将来的验证可为临床预后工具带来有希望的作用。

PURPOSE:Appearance of geographic atrophy (GA) on color photography (CP) is preceded by specific features on spectral-domain optical coherence tomography (SD OCT). We aimed to build SD OCT-based risk assessment models for 5-year new onset of GA and central GA on CP.DESIGN:Prospective, longitudinal study.PARTICIPANTS:Age-Related Eye Disease Study 2 Ancillary SD OCT study participants with age-related macular degeneration (AMD) with bilateral large drusen or noncentral GA and at least 1 eye without advanced disease (n= 317).METHODS:For 1 eye per participant, qualitative and quantitative SD OCT variables were derived from standardized grading and semiautomated segmentation, respectively, at baseline. Up to 7 years later, annual outcomes were extracted and analyzed to fit multivariate logistic regression models and build a risk calculator.MAIN OUTCOME MEASURES:New onset of CP-visible GA and central GA.RESULTS:Over a follow-up median of 4.0 years and among 292 AMD eyes (without advanced disease at baseline) with complete outcome data, 46 (15.8%) developed central GA. Among 265 eyes without any GA on baseline CP, 70 (26.4%) developed CP-visible GA. Final multivariate models were adjusted for age. In the model for GA, the independent predicting SD OCT factors (P < 0.001-0.03) were: hyperreflective foci and retinal pigment epithelium (RPE) layer atrophy or absence, followed by choroid thickness in absence of subretinal drusenoid deposits, photoreceptor outer segment loss, RPE drusen complex volume, and RPE drusen complex abnormal thinning volume. For central GA, the factors (P < 0.001) were RPE drusen complex abnormal thinning volume, intraretinal fluid or cystoid spaces, hyperreflective foci, and RPE layer atrophy or absence. The models yielded a calculator that computes the probabilities of CP-visible, new-onset GA and central GA after 1 to 5 years.CONCLUSIONS:For AMD eyes with large drusen and no advanced disease, we built a novel risk assessment model-based on age and SD OCT segmentation, drusen characteristics, and retinal pathology-for progression to CP-visible GA over up to 5 years. This calculator may simplify SD OCT grading and with future validation has a promising role as a clinical prognostic tool.


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