Topography of Geographic Atrophy in Age-Related Macular Degeneration
Topography of Geographic Atrophy in Age-Related Macular Degeneration
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DOI：
10.1167/iovs.12-9711
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发表时间：
2012-07-01
影响因子：
4.4
通讯作者：
Schmitz-Valckenberg, Steffen
中科院分区：
文献类型：
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作者：
Mauschitz, Matthias M.;Fonseca, Sofia;Schmitz-Valckenberg, Steffen
目的.目的探讨AMD患者地图样萎缩（GA）的地形分布和进展。回顾性分析了地理性萎缩进展（GAP）研究中413例受试者（中位年龄，77.0岁;四分位距[IQR]，72.0-82.0岁）413只眼的眼底自体荧光图像（激发488，发射500-700 nm）。使用改良的早期治疗糖尿病视网膜病变研究网格将后极分为9个不同的子视野加上周边，确定萎缩斑块的定位、大小和进展。使用Friedman检验比较子场、区域（中心、内部和外部）和切片（鼻、颞、下部、上级）。几乎所有的眼睛（>95%）都累及中央和内区，而萎缩在外区亚区较少见（76%）。内区萎缩尺寸（中位数4.00 mm（2））和进展率（0.67 mm（2）/年）显著大于外区（0.60 mm（2）和0.42 mm（2）/年; P < 0.001）。随着萎缩总面积的增加，有外区亚区和外周受累的趋势。此外，与网格的其他三个外子野相比，上级外子野受萎缩的影响更大（P < 0.001）。现有的GA补丁的分布和进展既依赖于偏心距中心和总的GA大小。黄斑中心区最易发生和扩大GA。精确分析分布和定向传播对于了解疾病的自然史非常重要。这些信息可能有助于设计介入性GA临床试验和相关的解剖结局指标。（临床试验。政府编号，NCT 00599846。）（Invest Ophthalmol维斯科学。2012;53：4932-4939）DOI：10.1167/iovs.12-9711
PURPOSE. To determine the topographic distribution and progression of geographic atrophy (GA) in patients with AMD.METHODS. Fundus autofluorescence images (excitation 488, emission 500-700 nm) from 413 eyes of 413 subjects (median age, 77.0 years; inter quartile range [IQR], 72.0-82.0 years) of the Geographic Atrophy Progression (GAP) study were retrospectively analyzed. Using a modified Early Treatment Diabetic Retinopathy Study grid to divide the posterior pole into nine different subfields plus periphery, the localization, size, and progression of atrophic patches were determined. Subfields, zones (center, inner and outer), and slices (nasal, temporal, inferior, superior) were compared using the Friedman test.RESULTS. The center and inner zones were involved in almost all eyes (>95%), while atrophy was less common in the outer zone subfields (76%). Inner zone atrophy size (median 4.00 mm(2)) and progression rate (0.67 mm(2)/year) were significantly greater than in the outer zone (0.60 mm(2) and 0.42 mm(2)/year; P < 0.001). There was a trend toward outer zone subfield and periphery involvement with increasing total size of atrophy. In addition, the superior outer subfield was significantly more affected by atrophy as compared with the other three outer subfields of the grid (P < 0.001).CONCLUSIONS. Distribution and progression of existing GA patches depended both on the eccentricity from the center and total GA size. Central macular areas appeared most susceptible for the occurrence and expansion of GA. Refined analysis of distribution and directional spread is important to understand the natural history of the disease. This information will likely be helpful to design interventional GA clinical trials and associated anatomical outcome measures. (ClinicalTrials. gov number, NCT00599846.) (Invest Ophthalmol Vis Sci. 2012;53:4932-4939) DOI:10.1167/iovs.12-9711