Structural Changes Associated with Delayed Dark Adaptation in Age-Related Macular Degeneration
Structural Changes Associated with Delayed Dark Adaptation in Age-Related Macular Degeneration
复制标题
DOI：
10.1016/j.ophtha.2017.03.061
复制
发表时间：
2017-09-01
期刊：
影响因子：
13.7
通讯作者：
Husain, Deeba
中科院分区：
文献类型：
--
作者：
Lains, Ines;Miller, John B.;Husain, Deeba
目的：探讨暗适应（DA）与基于光学相干断层扫描（OCT）的老年性黄斑变性（AMD）黄斑形态的关系。设计：前瞻性横断面研究。参与者：AMD患者和对照组（50岁），无任何玻璃体视网膜疾病。方法：对所有参与者进行光谱域OCT成像和眼底彩色照片，然后进行AMD（年龄相关性眼病研究系统）分期。两只眼睛用AdaptDx (MacuLogix, Middletown， PA) DA扩展协议（20分钟）进行测试。开发了一个软件程序，将DA测试点（2度圆，比中央凹高5度）映射到OCT b扫描。两名独立评分者评估了该测试点以及整个黄斑的b片，记录了几个amd相关异常的存在。采用多水平混合效应模型（考虑两眼之间的相关结果）进行分析。主要结局指标：主要结局指标是杆截时间（RIT），定义为分钟，是一个连续变量。对于在测试20分钟内无法达到RIT的受试者，赋值20。结果：纳入137只眼（n = 77）， 72.3% （n = 99）为AMD，其余为对照组。多变量分析显示，即使在调整了年龄和AMD分期后，DA测试点内的任何异常（beta = 4.8, P < 0.001）以及黄斑的任何异常（beta = 2.4, P = 0.047）都与延迟的RITs显著相关，因此DA受损。在DA检查点内无结构改变的眼睛中（n = 76, 55.5%），其余黄斑出现异常仍与延迟性RITs相关（beta = 2.00, P = 0.046）。视网膜下结节样物质沉积和椭球区破坏是RIT的一致预测因子，无论是位于DA测试点（两者P = 0.001）还是黄斑的任何地方（两者P < 0.001）。在试验点内，典型的结节性或浆液性色素上皮脱离也与DA损伤显著相关(P
Purpose: To examine the relationship between dark adaptation (DA) and optical coherence tomography (OCT)-based macular morphology in age-related macular degeneration (AMD).Design: Prospective, cross-sectional study.Participants: Patients with AMD and a comparison group (>50 years) without any vitreoretinal disease.Methods: All participants were imaged with spectral-domain OCT and color fundus photographs, and then staged for AMD (Age-related Eye Disease Study system). Both eyes were tested with the AdaptDx (MacuLogix, Middletown, PA) DA extended protocol (20 minutes). A software program was developed to map the DA testing spot (2 degrees circle, 5 degrees superior to the fovea) to the OCT B-scans. Two independent graders evaluated the B-scans within this testing spot, as well as the entire macula, recording the presence of several AMD-associated abnormalities. Multilevel mixed-effects models (accounting for correlated outcomes between 2 eyes) were used for analyses.Main Outcome Measures: The primary outcome was rod-intercept time (RIT), defined in minutes, as a continuous variable. For subjects unable to reach RIT within the 20 minutes of testing, the value of 20 was assigned.Results: We included 137 eyes (n = 77 subjects), 72.3% (n = 99 eyes) with AMD and the remainder belonging to the comparison group. Multivariable analysis revealed that even after adjusting for age and AMD stage, the presence of any abnormalities within the DA testing spot (beta = 4.8, P < 0.001), as well as any abnormalities in the macula (beta = 2.4, P = 0.047), were significantly associated with delayed RITs and therefore impaired DA. In eyes with no structural changes within the DA testing spot (n = 76, 55.5%), the presence of any abnormalities in the remaining macula was still associated with delayed RITs (beta = 2.00, P = 0.046). Presence of subretinal drusenoid deposits and ellipsoid zone disruption were a consistent predictor of RIT, whether located within the DA testing spot (P = 0.001 for both) or anywhere in the macula (P < 0.001 for both). Within the testing spot, the presence of classic drusen or serous pigment epithelium detachment was also significantly associated with impairments in DA (P