Correlation between the area of increased autofluorescence surrounding geographic atrophy and disease progression in patients with AMD
Correlation between the area of increased autofluorescence surrounding geographic atrophy and disease progression in patients with AMD
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DOI：
10.1167/iovs.05-0892
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发表时间：
2006-06-01
影响因子：
4.4
通讯作者：
Holz, Frank G.
中科院分区：
文献类型：
--
作者：
Schmitz-Valckenberg, Steffen;Bindewald-Wittich, Almut;Holz, Frank G.
目的.目的：探讨老年性黄斑变性（AMD）患者眼底自发荧光（FAF）增强区与地图样萎缩（GA）扩散率的相关性。对2003年8月底招募的GA患者进行了多中心纵向AMD自然病史眼底自发荧光（FAM）研究数据库的审查，随访检查至少在1年内。仅选择具有足够图像质量和周围萎缩的FAF增加的弥漫性模式的眼睛。在标准化数字FAF图像（激发，488 nm;发射，> 500 nm）中，测量GA的总尺寸和扩散。FAF增加的凸船体（CH）作为包围中央萎缩斑块周围FAF增加的整个区域的最小多边形，在基线时进行定量。采用斯皮尔曼秩相关系数（p）. SPSS进行统计学分析。纳入了32例患者的39只眼（中位年龄，75.0岁;四分位距[IQR]，67.8-78.9）;中位随访时间，1.87年; IQR，1.43-3-37）。基线时，萎缩的中位总尺寸为7.04 mm（2）（IQR，4.20-9.88）。CH的中位尺寸为21.47 mm（2）（IQR，15-19-28.26）。GA进展的中位速率为每年1.72 mm（2）（IQR，1.10-2.83）。萎缩周围FAF增加的面积（基线时CH和总GA大小之间的差异）与GA随时间的扩大呈正相关（p = 0.60; P = 0.0002）。眼底照相或荧光素血管造影未发现的FAF特征可作为晚期萎缩性AMD的预后决定因素。由于FAF信号来源于有丝分裂后RPE细胞中的脂褐素（LF），并且由于FAF增加表明LF过度积累，因此这些发现将强调RPE-LF在AMD发病机制中的病理生理作用。
PURPOSE. To test the hypothesis that the extension of areas with increased fundus autofluorescence (FAF) outside atrophic patches correlates with the rate of spread of geographic atrophy (GA) over time in eyes with age-related macular degeneration (AMD).METHODS. The database of the multicenter longitudinal natural history Fundus Autolluorescence in AMD (FAM) Study was reviewed for patients with GA recruited through the end of August 2003, with follow-up examinations within at least I year. Only eyes with sufficient image quality and with diffuse patterns of increased FAF surrounding atrophy were chosen. In standardized digital FAF images (excitation, 488 nm; emission, > 500 nm), total size and spread of GA was measured. The convex hull (CH) of increased FAF as the minimum polygon encompassing the entire area of increased FAF surrounding the central atrophic patches was quantified at baseline. Statistical analysis was performed with the Spearman's rank correlation coefficient (p).RESULTS. Thirty-nine eyes of 32 patients were included (median age, 75.0 years; interquartile range [IQR], 67.8-78.9); median follow-up, 1.87 years; IQR, 1.43-3-37). At baseline, the median total size of atrophy was 7.04 mm(2) (IQR, 4.20-9.88). The median size of the CH was 21.47 mm(2) (IQR, 15-19-28.26). The median rate of GA progression was 1.72 mm(2) per year (IQR, 1.10-2.83). The area of increased FAF around the atrophy (difference between the CH and the total GA size at baseline) showed a positive correlation with GA enlargement over time (p = 0.60; P = 0.0002).CONCLUSIONS. FAF characteristics that are not identified by fun dus photography or fluorescein angiography may serve as a prognostic determinant in advanced atrophic AMD. As the FAF signal originates from lipofuscin (LF) in postmitotic RPE cells and since increased FAF indicates excessive LF accumulation, these findings would underscore the pathophysiological role of RPE-LF in AMD pathogenesis.