进展期年龄相关性黄斑变性成像模式及应用专家共识(2024)

Expert consensus on imaging model and application of advancing age-related macular degeneration (2024)

进展期年龄相关性黄斑变性(AMD)病理改变以外层视网膜萎缩和变薄,视网膜色素上皮变性、增生或萎缩以及黄斑新生血管为主,包括地图样萎缩和湿性AMD,严重危害患者视力。目前,检测、量化和监测进展期AMD的眼底成像模式主要包括彩色眼底照相、眼底自发荧光、眼底近红外反射、眼底光学相干断层扫描成像、荧光素眼底血管造影和吲哚菁绿血管造影等。近年来发展的眼底成像模式包括眼底光学相干断层扫描血管成像、炫彩眼底成像、广角照相成像和多光谱成像等,也广泛应用于进展期AMD的成像检查。这些进展期AMD成像模式的最优化选择对于检测、量化和监测进展期AMD至关重要,并可能会影响相关临床诊疗的时效和成本。目前,进展期AMD成像面临的主要挑战是成像方案的选择和图像分析算法技术的研究。然而,国内外在检测、量化和监测进展期AMD的传统及当代先进的成像模式方面尚未达成共识。因此,本共识专家组就进展期AMD的各种成像模式进行了系统性讨论,在大量临床病例进行大样本分析的基础上,评估了各种成像模式的优缺点,并对每种成像模式在进展期AMD未来研究中的作用进行了系统总结。本共识专家组针对进展期AMD诊断和监测的不同阶段,结合经济效益成本分析,提出了各种适用技术的选择方法建议。

Pathological changes of advancing age-related macular degeneration(AMD)is characterized by outer retinal atrophy and thinning,degeneration,proliferation or atrophy of the retinal pigment epithelium,and the presence of macular neovascularization including geographic atrophy and wet AMD,which can seriously impair visual function.Currently,imaging modalities for detecting,quantifying,and monitoring the fundus of advancing AMD include color fundus photography,fundus autofluorescence,near-infrared reflectance,optical coherence tomography,fundus fluorescein angiography,and indocyanine green angiography.Advanced imaging modalities such as optical coherence tomography angiography,multicolor fundus photography,widefield photography,and multispectral imaging have also been widely used for imaging advancing AMD.The optimal selection of these imaging modalities is critical for detecting,quantifying,and monitoring advancing AMD,and may affect the timeliness and cost of clinical diagnosis and treatment.The main challenges currently facing advancing AMD imaging include selecting the best imaging modality and developing image analysis algorithms.However,there is currently no consensus on the traditional and contemporary advanced imaging modalities for detecting,quantifying,and monitoring advancing AMD,both domestically and internationally.Therefore,the consensus expert group conducted a systematic discussion on the various imaging modalities for advancing AMD,evaluated their advantages and disadvantages based on a large sample analysis of numerous clinical cases,and systematically summarized the role of each imaging modality in future research on advancing AMD.In combination of economic efficacy cost analysis,the consensus expert group put forward suggestions on choosing optimal techniques for diagnosis and monitoring of advancing AMD at different stages.