REGRESSION OF TYPE 2 NEOVASCULARIZATION INTO A TYPE 1 PATTERN AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
REGRESSION OF TYPE 2 NEOVASCULARIZATION INTO A TYPE 1 PATTERN AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
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DOI：
10.1097/iae.0000000000001279
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发表时间：
2017-02-01
影响因子：
3.3
通讯作者：
Freund, K. Bailey
中科院分区：
文献类型：
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作者：
Dolz-Marco, Rosa;Phasukkijwatana, Nopasak;Freund, K. Bailey
目的：研究继发于新生血管性年龄相关性黄斑变性（nAMD）的2型（视网膜下）新生血管（NV）眼，在玻璃体内抗血管内皮生长因子（VEGF）治疗后，nAMD显示病变消退为1型（视网膜下色素上皮）模式。在被视网膜色素上皮覆盖后，显示2型新血管形成消退为1型模式的患者包括在该分析中。在基线、1、3、6和12个月时对这些病例的临床记录和多模式成像进行审查。人口统计学数据，最佳矫正视力（BCVA），彩色眼底照相，眼底自发荧光（FAF），荧光素血管造影，近红外反射（NIR），和结构光谱域光学相干断层扫描（SD-OCT）进行了审查和分析。当可用时，光学相干断层扫描血管造影图像进行了分析，以及。结果：9例患者（6名男性）的10只眼睛被诊断为治疗初治的纯2型新生血管继发于nAMD。平均年龄为80.7岁（SD +/- 4.30）。基线时平均最佳矫正视力（以logMAR（Snellen）表示）为0.45 ± 0.20（20/55），3个月随访时显著改善至0.22 ± 0.13（20/32）（P值：0.007）。基线时，彩色照片和眼底自发荧光显示6只眼新生血管病变周围有色素环。在3个月随访时，所有眼睛的NIR上均可见高反射环。彩色照片显示，在10只眼中，9只眼底呈棋盘格状。系列结构光谱域光学相干断层扫描显示2型病变逐渐消退为1型模式，并由视网膜色素上皮细胞覆盖。正面和横截面光学相干断层扫描血管造影显示基线视网膜下血流模式，治疗后，表现出减少流量下一个完整的高反射视网膜色素上皮细胞（RPE）bands.Conclusion：纯2型病变是罕见的nAMD，往往导致不良的视力结果相关的视网膜下纤维化。我们描述了一种交替的回归模式发生在早期2型病变的眼睛玻璃体内抗血管内皮生长因子治疗，其中新生血管组织被视网膜色素上皮细胞包裹，产生1型模式。这些眼睛似乎比通常在与减少外部视网膜损伤相关的2型病变中看到的具有更好的视觉结果。
Purpose: To study eyes with Type 2 (subretinal) neovascularization (NV) secondary to neovascular age-related macular degeneration (nAMD) that shows lesion regression into a Type 1 (subretinal pigment epithelium) pattern after treatment with intravitreal anti-vascular endothelial growth factor (VEGF) therapy.Methods: Retrospective consecutive case series. Patients showing regression of Type 2 neovascularization into a Type 1 pattern after envelopment by retinal pigment epithelium were included in this analysis. A review of the clinical records and multimodal imaging of these cases was performed at baseline, 1, 3, 6, and 12 months. Demographic data, best-corrected visual acuity (BCVA), color fundus photography, fundus autofluorescence (FAF), fluorescein angiography, near-infrared reflectance (NIR), and structural spectral-domain optical coherence tomography (SD-OCT) were reviewed and analyzed. When available, optical coherence tomography angiography images were analyzed as well.Results: Ten eyes of 9 patients (6 males) diagnosed with treatment-naive pure Type 2 neovascularization secondary to nAMD were included. The mean age was 80.7 years (SD +/- 4.30). Mean best-corrected visual acuity expressed in logMAR (Snellen) was 0.45 +/- 0.20 (20/55) at baseline and significantly improved to 0.22 +/- 0.13 (20/32) at 3-month follow-up (P-value: 0.007). At baseline, color photographs and fundus autofluorescence showed a pigment ring around the neovascular lesion in 6 eyes. A hyperreflective ring was visible on NIR in all eyes at 3-month follow-up. Color photographs showed a tessellated fundus appearance in 9 of the 10 eyes. Serial structural spectral-domain optical coherence tomography scans showed the gradual regression of the Type 2 lesions into a Type 1 pattern with envelopment by the retinal pigment epithelium. En face and cross-sectional optical coherence tomography angiography showed baseline subretinal flow patterns which, after treatment, exhibited reduced flow beneath an intact hyperreflective retinal pigment epithelium (RPE) band.Conclusion: Pure Type 2 lesions are infrequent in nAMD, often leading to poor visual outcomes related to subretinal fibrosis. We describe an alternate regression pattern occurring in eyes with early Type 2 lesions treated with intravitreal anti-vascular endothelial growth factor therapy in which the neovascular tissue is enveloped by retinal pigment epithelium producing a Type 1 pattern. These eyes appear to have better visual outcomes than typically seen with Type 2 lesions related to reduced outer retinal damage.