A paradigm shift in imaging biomarkers in neovascular age-related macular degeneration
A paradigm shift in imaging biomarkers in neovascular age-related macular degeneration
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DOI：
10.1016/j.preteyeres.2015.07.007
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发表时间：
2016-01-01
影响因子：
17.8
通讯作者：
Waldstein, Sebastian M.
中科院分区：
文献类型：
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作者：
Schmidt-Erfurth, Ursula;Waldstein, Sebastian M.
新生血管性年龄相关性黄斑变性（AMD）在诊断和治疗方面已经经历了实质性的突破，光学相干断层扫描（OCT）允许非常详细地识别疾病形态，并且玻璃体内抗血管内皮生长因子治疗提供了前所未有的益处。然而，这两条路径尚未以最佳方式结合，现实世界的结果不如预期，疾病管理在现实世界中的效率很低。这一困境可以通过识别与视功能、疾病活动和预后相关的有效生物标志物来解决，这可以为个体水平和人群基础上的治疗管理提供坚实的指导。高级OCT获得的定性和定量形态学特征为新生血管性AMD的渗出和退行性阶段提供了新的见解。然而，结构/功能相关性的结论与以前的范式不同。虽然在临床试验和实践中，中央视网膜厚度被用作指导再治疗管理的生物标志物，但不同隔室中的液体定位提供了更好的预后价值：视网膜内囊样液对视力有负面影响，并且在持续通过初始治疗间隔时被认为是退行性的。视网膜下液与上级视力益处和较低的地图状萎缩进展率相关。视网膜色素上皮脱落被确定为最特异的生物标志物，通常对治疗无反应，并在促再生方案期间导致视力下降。感觉神经组织的改变通常与功能元件的不可逆损失和不良预后相关。新型OCT技术提供了对感光视网膜色素上皮-脉络膜毛细血管单元水平相应变化的关键洞察，确定了治疗干预的生物学限制。为了从高分辨率多模态成像中获得最佳收益，需要对所有功能和结构特征进行综合分析，包括可靠的自动算法和计算数据分析。使用创新的分析方法，视网膜生物标志物可用于为个体患者提供有效的个性化治疗，预测基于疾病和人群的大规模管理模型，并为开发新的治疗策略确定有前途的目标。(C)2015爱思唯尔有限公司版权所有。
Neovascular age-related macular degeneration (AMD) has undergone substantial break-throughs in diagnostic as well as therapeutic respect, with optical coherence tomography (OCT) allowing to identify disease morphology in great detail, and intravitreal anti-vascular endothelial growth factor therapy providing unprecedented benefit. However, these two paths have yet not been combined in an optimal way, real-world outcomes are inferior to expectations, and disease management is largely inefficient in the real-world setting. This dilemma can be solved by identification of valid biomarkers relevant for visual function, disease activity and prognosis, which can provide solid guidance for therapeutic management on an individual level as well as on the population base.Qualitative and quantitative morphological features obtained by advanced OCT provide novel insight into exudative and degenerative stages of neovascular AMD. However, conclusions from structure/function correlations evolve differently from previous paradigms. While central retinal thickness was used as biomarker for guiding retreatment management in clinical trials and practice, fluid localization in different compartments offers superior prognostic value: Intraretinal cystoid fluid has a negative impact on visual acuity and is considered as degenerative when persisting through the initial therapeutic interval. Subretinal fluid is associated with superior visual benefit and a lower rate of progression towards geographic atrophy. Detachment of the retinal pigment epithelium was identified as most pathognomonic biomarker, often irresponsive to therapy and responsible for visual decline during a pro-re-nata regimen. Alterations of neurosensory tissue are usually associated with irreversible loss of functional elements and a negative prognosis. Novel OCT technologies offer crucial insight into corresponding changes at the level of the photoreceptor retinal pigment epithelial - choriocapillary unit, identifying the biological limits of therapeutic interventions.To optimally benefit from high-resolution multi-modal imaging, an integrated analysis of all functional and structural features is required involving reliable automated algorithms and computational data analyses. Using innovative analysis methods, retinal biomarkers can be used to provide efficient personalized therapy for the individual patient, predictive disease- and population-based models for large-scale management and identifying promising targets for the development of novel therapeutic strategies. (C) 2015 Elsevier Ltd. All rights reserved.