Directional Kinetics of Geographic Atrophy Progression in Age-Related Macular Degeneration with Foveal Sparing
Directional Kinetics of Geographic Atrophy Progression in Age-Related Macular Degeneration with Foveal Sparing
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DOI：
10.1016/j.ophtha.2015.03.027
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发表时间：
2015-07-01
期刊：
影响因子：
13.7
通讯作者：
Fleckenstein, Monika
中科院分区：
文献类型：
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作者：
Lindner, Moritz;Boeker, Alexander;Fleckenstein, Monika
用途：描述地图状萎缩（GA）在年龄相关性黄斑变性和中心凹保留的眼睛中扩散的方向动力学。设计：前瞻性，非干预性自然史研究：视网膜相关性黄斑变性（FAM）的眼底自体荧光成像;临床试验。方法：用眼底自发荧光（FAF;激发波长，488 nm;发射波长，>500 nm）和近红外（NIR）反射成像（Spectralis HRA_OCT或HRA 2; Heidelberg Engineering，Heidelberg，德国）纵向检查眼睛。由2名独立的读取器使用允许组合NIR反射率和FAF图像分级的半自动软件工具（Regionaldom; Heidelberg Engineering）测量中央凹保留和GA的面积。采用线性混合效应模型对GA动力学随时间的变化进行建模。主要结果测量：GA病变大小随时间的变化（中心与周边进展）。结果：36例患者（平均年龄73.8 ± 7.5岁）共47只眼符合纳入标准。平均随访时间为25.2 ± 16.9个月（范围：5.9-74.6个月）。GA和中心凹保留大小测量的阅片者间一致性分别为0.995和0.946。GA向外周的平均面积进展为2.27 +/- 0.22 mm（2）/年，向中心的平均面积进展为0.25 +/-0.03 mm（2）/年。对转换数据的分析显示，周边的萎缩进展比中心凹快2.8倍。更快的萎缩进展向中央凹与更快的进展向周边存在显着的interindividual differences.Conclusions：结果表明，一个显着更快的离心比向心GA传播的眼睛与GA和中央凹保留。虽然差异性GA进展的潜在病理机制仍不清楚，但局部因素可能是保护中央凹视网膜色素上皮复合体的有效因素。定向扩散特征的量化和建模可能有助于设计旨在延长GA患者中心凹存活率的干预性临床试验。(C)2015年，美国眼科学会。
Purpose: To describe the directional kinetics of the spread of geographic atrophy (GA) spread in eyes with age-related macular degeneration and foveal sparing.Design: Prospective, noninterventional natural history study: Fundus Autofluorescence Imaging in Age-Related Macular Degeneration (FAM; clinicaltrials. gov identifier, NCT00393692).Subjects: Participants of the FAM study exhibiting foveal sparing of GA.Methods: Eyes were examined longitudinally with fundus autofluorescence (FAF; excitation wavelength, 488 nm; emission wavelength, >500 nm) and near infrared (NIR) reflectance imaging (Spectralis HRA_OCT or HRA2; Heidelberg Engineering, Heidelberg, Germany). Areas of foveal sparing and GA were measured by 2 independent readers using a semiautomated software tool that allows for combined NIR reflectance and FAF image grading (RegionFinder; Heidelberg Engineering). A linear mixed effect model was used to model GA kinetics over time.Main Outcome Measure: Change of GA lesion size over time (central vs. peripheral progression).Results: Atotal of 47 eyes of 36 patients (mean age, 73.8 +/- 7.5 years) met the inclusion criteria. Mean follow-up time was 25.2 +/- 16.9 months (range, 5.9-74.6 months). Interreader agreement for measurements of GA and foveal-sparing size were 0.995 and 0.946, respectively. Mean area progression of GA toward the periphery was 2.27 +/- 0.22 mm(2)/year and 0.25 +/- 0.03mm(2)/year toward the center. Analysis of square rootetransformeddata revealeda 2.8-fold faster atrophy progression toward the periphery than toward the fovea. Faster atrophy progression toward the fovea correlated with faster progression toward the periphery in presence of marked interindividual differences.Conclusions: The results demonstrate a significantly faster centrifugal than centripetal GA spread in eyes with GA and foveal sparing. Although the underlying pathomechanisms for differential GA progression remain unknown, local factors may be operative that protect the foveal retinaeretinal pigment epithelial complex. Quantification of directional spread characteristics and modeling may be useful in the design of interventional clinical trials aiming to prolong foveal survival in eyes with GA. (C) 2015 by the American Academy of Ophthalmology.