Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials.
Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials.
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DOI：
10.1016/j.ophtha.2015.05.042
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发表时间：
2015-09
期刊：
影响因子：
13.7
通讯作者：
Comparison of Age-Related Macular Degeneration Treatments Trials Research Group
中科院分区：
文献类型：
--
作者：
Willoughby AS;Ying GS;Toth CA;Maguire MG;Burns RE;Grunwald JE;Daniel E;Jaffe GJ;Comparison of Age-Related Macular Degeneration Treatments Trials Research Group
在一项随机临床试验中的年龄相关性黄斑变性治疗试验（CATT）前瞻性队列研究中，评价视网膜下高反射物质（SHRM）与视力（VA）、地图状萎缩（GA）和瘢痕的相关性。参加CATT的1185人。参与者被随机分配到雷珠单抗或贝伐单抗治疗每月或按需。在104周内，盲读者对眼底照相和荧光素血管造影图像上的瘢痕和GA进行分级，SHRM对时域（TD）和谱域（SD）光学相干断层扫描（OCT）进行分级。在56周（n=76）和104周（n=66）时，在SD-OCT图像上测量中心凹、中心内1 mm 2或中心外1 mm 2的SHRM高度和宽度。VA由经认证的检查员测量。SHRM的存在、位置和大小，以及与VA、瘢痕和GA的相关性。在所有CATT参与者中，入组时SHRM的比例为77%，治疗后4周降至68%，104周时降至54%。在104周时，持续性SHRM的眼睛比消退的SHRM的眼睛更常出现瘢痕（64% vs. 31%; p<0.0001）。在第56周（n=76）和第104周（n=66）时对SHRM进行详细评价的患眼中，当SHRM不存在、存在于中央1 mm 2外、存在于中央1 mm 2内但不存在于中央凹中心时，平均[SE] VA字母评分分别为73.5 [2.8]、73.1 [3.4]、65.3 [3.5]和63.9 [3.7]，或存在于中央凹中心（p=0.02）。SHRM位于中心凹中心43例（30%），中心凹内1 mm ~ 2 21例（15%），中心凹外1 mm ~ 2 19例（13%）。当存在SHRM时，中央凹下、包括中央凹在内的中央1 mm 2内和扫描内任何地方的中位最大高度（以微米计）分别为86、120和122。VA随着SHRM高度和宽度的增加而降低（p<0.05）。SHRM在NVAMD患者中很常见，并且通常在抗VEGF治疗后持续存在。2年时，有疤痕的眼睛比其他眼睛更容易发生SHRM。较大的SHRM高度和宽度与较差的VA相关。SHRM是NVAMD眼的重要形态学标志物。
To evaluate the association of subretinal hyper-reflective material (SHRM) with visual acuity (VA), geographic atrophy (GA) and scar in the Comparison of Age related Macular Degeneration Treatments Trials (CATT) Prospective cohort study within a randomized clinical trial. The 1185 participants in CATT. Participants were randomly assigned to ranibizumab or bevacizumab treatment monthly or as-needed. Masked readers graded scar and GA on fundus photography and fluorescein angiography images, SHRM on time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1mm2, or outside the center 1mm2 were obtained on SD-OCT images at 56 (n=76) and 104 (n=66) weeks. VA was measured by certified examiners. SHRM presence, location and size, and associations with VA, scar, and GA. Among all CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than eyes with SHRM that resolved (64% vs. 31%; p<0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n=76) and 104 (n=66), mean [SE] VA letter score was 73.5 [2.8], 73.1 [3.4], 65.3 [3.5], and 63.9 [3.7] when SHRM was absent, present outside the central 1mm2, present within the central 1mm2 but not the foveal center, or present at the foveal center (p=0.02). SHRM was present at the foveal center in 43 (30%), within the central 1mm2 in 21 (15%) and outside the central 1mm2 in 19 (13%). When SHRM was present, the median maximum height in microns under the fovea, within the central 1 mm2 including the fovea and anywhere within the scan was 86; 120; and 122, respectively. VA was decreased with greater SHRM height and width (p<0.05). SHRM is common in eyes with NVAMD and often persists after anti-VEGF treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM height and width were associated with worse VA. SHRM is an important morphological biomarker in eyes with NVAMD.