较大的无血管性PED的预后观察

Prognosis of large avascular PED

目的 观察并分析干性年龄相关性黄斑变性(AMD)相关的较大的无血管性视网膜色素上皮脱离(aPED)的变化及转归特点。设计回顾性病例系列。研究对象2013年1月至2023年1月就诊于北京同仁眼科中心,诊断为干性AMD相关的较大的(PED最大水平直径>1500μm,高度>165μm)aPED患者15例(17眼)。方法回顾性分析15例(17眼)较大aPED患者的病历资料,所有患者均经FFA+ICGA+OCT确诊,平均随访时间为(19.76±17.39)个月。观察记录OCT的特点(脉络膜厚度,PED高度、底径宽度,PED塌陷,RPE增殖,视网膜内囊腔,视网膜内高反射灶、视网膜下液,RPE撕裂),地图样萎缩,新生血管形成及最佳矫正视力(BCVA,LogMAR)变化情况。主要指标BCVA,OCT所测量的脉络膜厚度及PED高度、底径宽度。结果基线时平均LogMAR视力为0.55±0.31,黄斑中心脉络膜厚度平均为(237.29±77.39)μm,PED高度平均为(476.67±313.83)p m,PED底径宽度平均为(3268.17±1482.28)μm。末次随访LogMAR视力为0.70±0.34,较基线时明显变差(t=-2.842,P=0.012)。基线时存在PED塌陷的5眼中,4眼出现了地图样萎缩,另1例的RPE增殖及塌陷均加重,且视网膜内出现囊腔;基线时存在视网膜内囊腔的1眼,末次随访出现了地图样萎缩;随访期间PED高度及底径宽度均变大的有6眼(35.29%),其中5眼RPE增殖加重,1眼无明显变化;PED底径宽度变大、高度降低的有4眼(23.53%),均出现PED的塌陷;1眼发生了RPE撕裂(5.89%);2眼无明显变化(11.76%),均未见到有新生血管的发生。在末次随访时,黄斑中心脉络膜厚度为(223.12±67.53)μm,与基线时无明显变化(t=1.712,P=0.106),末次随访存在PED的患者12例,PED高度平均为(370.08±242.25)μm,底径宽度平均为(3545.17±1313.10)μm,与基线比较均无统计学差异(t=1.409、-2.105,P=0.186、0.059)。结论对于干性AMD相关的较大aPED,其自然预后多转化为地图样萎缩,严重影响患者的视力;RPE塌陷及视网膜内囊腔的出现,可作为病情进展的生物标志物,需要引起临床医生的足够重视,增加随访次数,以期能及早发现病情变化。

Objective To observe and analyze the changes and prognostic characteristics of large avascular retinal pigment detachment(aPED)associated with dry age-related macular degeneration(AMD).Design Retrospective case series.Participants 17 eyes of 15 cases diagnosed with large(the maximum horizontal diameter of PED is greater than 1500μm,the height is greater than 165μm)aPED in dry AMD at Beijing Tongren Eye Center from January 2013 to January 2023.Methods We retrospectively analyzed the patients’medical records,and the average follow-up time was(19.76±17.39)months.The characteristics of OCT,including choroid thickness,PED height,PED width,RPE collapse,hyperplasia of RPE,inner retinal capsules,hyperreflective foci,subretinal fluid,RPE laceration,geograghic atrophy(GA),neovascularization,and the changes of best corrected visual acuity(BCVA)were evaluated.Main Outcome Measures The BCVA,the choroidal thickness and the height and width of PED measured by OCT.Results At baseline,LogMAR BCVA was 0.55±0.31,the mean choroidal thickness of the macular center was(237.29±77.39)μm,the mean height of PED was(476.67±313.83)μm,and the mean width of PED was(3268.17±1482.28)μm.At the last follow-up,LogMAR BCVA was 0.70±0.34,which was significant worse than that at baseline(t=-2.842,P=0.012).In 5 eyes with PED collapse at baseline,4 eyes had GA,another 1 eye had the RPE proliferation aggravated and RPE collapse,and had inner retinal capsules during the follow-up.One eye with retinal inner capsule at baseline appeared GA during the follow-up.There were 6 eyes(35.29%)with increased height and width of PED,of which 5 eyes had increased proliferation of RPE and 1 eye had no significant change;there were 4 eyes(23.53%)with the width of PED bottom diameter increasing and the height decreasing,all of which had the collapse of PED;RPE laceration occurred in one eye(5.89%);There was no obvious change in 2 eyes(11.76%),and no neovascularization was seen.At the last follow-up,the mean choroidal thickness of the macular center was(223.12±67.53)μm,which was no significant difference with the baseline.There were 12 cases with PED at the last follow-up which the mean height of PED was(370.08±242.25)μm,and the mean width of PED was(3545.17±1313.10)μm.There was no significant difference with the baseline(t=1.409、-2.105,P=0.186、0.059).Conclusion For large aPED associated with dry AMD,its natural prognosis is mostly transformed into GA,which seriously affects the vision of patients.The collapse of RPE and the appearance of retinal inner capsule can be used as biomarkers for the progress of the disease.Clinicians should pay enough attention to the mand increase the number of follow-up visits so as to detect the changes of the disease as soon as possible.