Association Between the Cilioretinal Artery and Choroidal Neovascularization in Age-Related Macular Degeneration A Secondary Analysis From the Age-Related Eye Disease Study
Association Between the Cilioretinal Artery and Choroidal Neovascularization in Age-Related Macular Degeneration A Secondary Analysis From the Age-Related Eye Disease Study
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DOI：
10.1001/jamaophthalmol.2018.2650
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发表时间：
2018-09-01
影响因子：
8.1
通讯作者：
Yiu, Glenn
中科院分区：
文献类型：
--
作者：
Snyder, Kiersten;Yazdanyar, Amirfarbod;Yiu, Glenn
重要性在老年性黄斑变性(AMD)发病机制中的血流动力学作用已被提出，但据我们所知，视网膜血管与晚期AMD之间的关联尚未被调查。目的在年龄相关眼病研究(AREDS)中，确定睫状视网膜动脉的存在和位置是否可能与晚期AMD的风险相关。AREDS参与者的眼底照片由2名蒙面分级人员检查是否存在纤毛-视网膜动脉，以及是否有任何分支在中央黄斑500亩范围内延伸。根据年龄、性别和吸烟状况进行调整，通过多因素回归分析来确定睫状视网膜动脉和血管位置与脉络膜新生血管(CNV)或中心性地理萎缩(CGA)的患病率以及5年后眼部AMD严重程度评分的相关性。主要结果和测量结果：在AREDS参与者中，平均年龄(SD)为69.0(5.0)岁，其中女性56.3%，既往吸烟者46.6%，现在吸烟者6.9%。26.9%的患者1只眼有睫状视网膜动脉，8.4%的患者双眼有睫状视网膜动脉。在随机分组中，睫状视网膜动脉的CNV患病率较低(5.0%vs 7.6%；OR，0.66；95%CI，0.51-0.85；P=.001)，但CGA无差异(1.1%vs 0.8%；OR，1.33；95%CI)。0.76-2.32；P=.31)。在没有晚期AMD的眼睛中，那些有睫状视网膜动脉的人的AMD严重程度评分也较低(3.00[2.35]比3.19[2.40]；P=0.02)。在5年时，有睫状视网膜动脉的高危眼进展为CNV的比率较低(4.1%比53%；OR，0.75；95%CI，0.56-1.00；P=0.05)，但在发生CGA方面(2.2%比2.7%；OR，0.83；95%CI，0.56-1.23；P=.35)或AMD严重程度评分的变化(0.65[1.55]比0.73[1.70]；P=.11)。在有单侧睫状视网膜动脉的患者中，有血管的眼CNV的发生率低于对侧眼(4.7%比7.2%；P=.01)。结论和相关性：有睫状视网膜动脉的患者发生CNV的风险较低，但与CGA无关，提示视网膜血流动力学可能在新生血管性AMD的发病机制中起作用。
IMPORTANCE A hemodynamic role in the pathogenesis of age-related macular degeneration (AMD) has been proposed, but to our knowledge, an association between retinal vasculature and late AMD has not been investigated.OBJECTIVE To determine whether the presence and location of a cilioretinal artery may be associated with the risk of late AMD in the Age-Related Eye Disease Study (AREDS).DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of prospective, randomized clinical trial data from 3647 AREDS participants. Fundus photographs of AREDS participants were reviewed by 2 masked graders for the presence or absence of a cilioretinal artery and whether any branch extended within 500 mu m of the central macula. Multivariate regressions were used to determine the association of the cilioretinal artery and vessel location, adjusted for age, sex, and smoking status, with the prevalence of choroidal neovascularization (CNV) or central geographic atrophy (CGA) and AMD severity score for eyes at randomization and progression at 5 years.MAIN OUTCOMES AND MEASURES Association of cilioretinal artery with prevalence and 5-year incidence of CNV or CGA.RESULTS Among AREDS participants analyzed, mean (SD) age was 69.0 (5.0) years, with 56.3% female, 46.6% former smokers, and 6.9% current smokers. A total of 26.9% of patients had a cilioretinal artery in 1 eye, and 8.4% had the vessel bilaterally. At randomization, eyes with a cilioretinal artery had a lower prevalence of CNV (5.0% vs 7.6%; OR, 0.66; 95% CI, 0.51-0.85; P = .001) but no difference in CGA (1.1% vs 0.8%; OR, 1.33; 95% CI. 0.76-2.32; P = .31). In eyes without late AMD, those with a cilioretinal artery also had a lower mean (SD) AMD severity score (3.00 [2.35] vs 3.19 [2.40]; P = .02). At 5 years, eyes at risk with a cilioretinal artery had lower rates of progression to CNV (4.1% vs 53%; OR, 0.75; 95% CI, 0.56-1.00; P = .05) but no difference in developing CGA (2.2% vs 2.7%; OR, 0.83; 95% CI, 0.56-1.23; P = .35) or change in AMD severity score (0.65 [1.55] vs 0.73 [1.70]; P = .11). In patients with a unilateral cilioretinal artery, eyes with the vessel showed a lower prevalence of CNV than fellow eyes (4.7% vs 7.2%; P = .01).CONCLUSIONS AND RELEVANCE The presence of a cilioretinal artery is associated with a lower risk of developing CNV, but not CGA, suggesting a possible retinal hemodynamic contribution to the pathogenesis of neovascular AMD.