Fundus autofluorescence and optical coherence tomography biomarkers associated with the progression of geographic atrophy secondary to age-related macular degeneration
Fundus autofluorescence and optical coherence tomography biomarkers associated with the progression of geographic atrophy secondary to age-related macular degeneration
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DOI：
10.1038/s41433-021-01747-z
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发表时间：
2021-08-16
期刊：
影响因子：
3.9
通讯作者：
Schmidt-Erfurth, Ursula
中科院分区：
文献类型：
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作者：
Bui, Patricia T. A.;Reiter, Gregor S.;Schmidt-Erfurth, Ursula
目的 研究定性分级和深度学习量化成像生物标志物对继发于年龄相关性黄斑变性的地理萎缩 (GA) 生长的影响。方法 这项前瞻性研究包括 100 名 GA 患者的 181 只眼睛的 1062 次就诊。每次就诊时均采集谱域光学相干断层扫描 (SD-OCT) 和眼底自发荧光 (FAF) 图像。使用经过验证的深度学习算法在 SD-OCT 体积中对超反射灶 (HRF) 进行定量评估。 FAF 图像根据 FAF 模式、视网膜下玻璃疣样沉积物 (SDD)、GA 病变形态和萎缩扩大进行分级。计算线性混合模型以研究所有参数与 GA 进展之间的关联。结果 FAF 模式与 GA 进展显着相关 (p < 0.001)。 SDD 与较快的 GA 生长相关 (p = 0.005)。 HRF 浓度较高的眼睛表现出 GA 进展更快的趋势 (p = 0.072)，并揭示了与 FAF 模式相互作用对 GA 扩大的显着影响 (p = 0.01)。对侧眼状态对病变扩大没有显着影响（p > 0.05）。扩散滴流 FAF 模式的 HRF 浓度显着高于任何其他模式 (p < 0.001)。结论 在广泛研究的生物标志物中，SDD 和 FAF 模式，特别是与 HRF 的相互作用，显着影响 GA 进展。 HRF 等视网膜成像生物标志物的全自动定量既可靠又有价值，因为 HRF 是视网膜色素上皮畸形的指标，而视网膜色素上皮畸形是 GA 的主要发病机制。结合使用 FAF 和 SD-OCT 来识别疾病标志物具有很高的预后价值，并有助于临床环境中的个体化患者管理。
Objectives To investigate the impact of qualitatively graded and deep learning quantified imaging biomarkers on growth of geographic atrophy (GA) secondary to age-related macular degeneration. Methods This prospective study included 1062 visits of 181 eyes of 100 patients with GA. Spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) images were acquired at each visit. Hyperreflective foci (HRF) were quantitatively assessed in SD-OCT volumes using a validated deep learning algorithm. FAF images were graded for FAF patterns, subretinal drusenoid deposits (SDD), GA lesion configuration and atrophy enlargement. Linear mixed models were calculated to investigate associations between all parameters and GA progression. Results FAF patterns were significantly associated with GA progression (p < 0.001). SDD was associated with faster GA growth (p = 0.005). Eyes with higher HRF concentrations showed a trend towards faster GA progression (p = 0.072) and revealed a significant impact on GA enlargement in interaction with FAF patterns (p = 0.01). The fellow eye status had no significant effect on lesion enlargement (p > 0.05). The diffuse-trickling FAF pattern exhibited significantly higher HRF concentrations than any other pattern (p < 0.001). Conclusion Among a wide range of investigated biomarkers, SDD and FAF patterns, particularly in interaction with HRF, significantly impact GA progression. Fully automated quantification of retinal imaging biomarkers such as HRF is both reliable and merited as HRF are indicators of retinal pigment epithelium dysmorphia, a central pathogenetic mechanism in GA. Identifying disease markers using the combination of FAF and SD-OCT is of high prognostic value and facilitates individualized patient management in a clinical setting.