目的:评估哪些OCT预后生物标志物能最好地预测早期/中期至晚期年龄相关性黄斑变性(AMD)的进展风险。
结论:在超过100个AMD的OCT预后生物标志物中,目前尚不清楚临床医生和研究人员最关注的是什么.这篇综述评估了哪些OCT生物标志物对晚期AMD的进展具有最大程度的预测。
方法:研究方案已在PROSPERO(CRD42023400166)上注册。从开始到2023年3月2日搜索PubMed和Embase,并根据建议等级评估合格研究。评估,开发和评估(等级)方法。主要结果是从治疗初期早期/中期AMD到晚期AMD的任何量化进展风险,包括危险比(HR),赔率比(OR),和标准化的平均差(在基线,在有和没有进展的眼睛之间),按每个OCT生物标志物分组。进一步的荟萃分析通过进展为地理萎缩或新血管形成进行分组。
结果:共鉴定了114个定量的OCT预后生物标志物。证据的高度确定性,晚期AMD的最大预测幅度属于:外界膜异常(OR,15.42[7.63,31.17]),椭圆体区异常(OR,10.8[4.58,25.46]),叉指带异常(OR,7.68[2.57,23]),并发大玻璃疣和网状假玻璃疣(HR,6.73[1.35,33.65],低反射玻璃疣核(HR,2.48[1.8、3.4];或1.85[1.29、2.66]),视网膜内高反射灶(IHRF;HR,2.16[0.92,5.07];或5.08[3.26,7.92]),和大玻璃疣(HR,2.01[1.35,2.99]);或,1.98[1.27,3.08])。IHRF和低反射玻璃疣核的地理萎缩风险更大(P<0.05)。椭圆形区异常的新生血管化(P<0.05)。其他OCT生物标志物,如色斑样色素上皮脱离,浅不规则视网膜色素上皮升高,和新生的地理萎缩,表现出很大的风险,但需要进一步的研究进行验证。
结论:本综述综合了6种与AMD最相关的OCT预后生物标志物,其预测能力优于单独使用大型玻璃疣,供临床医生和研究人员关注。需要进一步的研究来验证其他生物标志物,但证据的确定性不高。并评估生物标志物的共存可能如何影响风险。
OBJECTIVE: To evaluate which OCT prognostic biomarkers best predict the risk of progression from early/intermediate to late age-related macular degeneration (AMD).
CONCLUSIONS: Among > 100 OCT prognostic biomarkers for AMD, it is unclear which are the most relevant for clinicians and researchers to focus on. This
review evaluated which OCT biomarkers confer the greatest magnitude of prediction for progression to late AMD.
METHODS: Study protocol was registered on PROSPERO (CRD42023400166). PubMed and Embase were searched from inception to March 2, 2023, and eligible studies assessed following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was any quantified risk of progression from treatment-naive early/intermediate AMD to late AMD, including hazard ratios (HRs), odds ratios (ORs), and standardized mean differences (at baseline, between eyes with versus without progression), subgrouped by each OCT biomarker. Further meta-analyses were subgrouped by progression to geographic atrophy or
neovascularization.
RESULTS: A total of 114 quantified OCT prognostic biomarkers were identified. With high GRADE certainty of evidence, the greatest magnitudes of prediction to late AMD belonged to: external limiting membrane abnormality (OR, 15.42 [7.63, 31.17]), ellipsoid zone abnormality (OR, 10.8 [4.58, 25.46]), interdigitation zone abnormality (OR, 7.68 [2.57, 23]), concurrent large drusen and reticular pseudodrusen (HR, 6.73 [1.35, 33.65], hyporeflective drusen cores (HR, 2.48 [1.8, 3.4]; OR 1.85 [1.29, 2.66]), intraretinal hyperreflective foci (IHRF; HR, 2.16 [0.92, 5.07]; OR 5.08 [3.26, 7.92]), and large drusen (HR, 2.01 [1.35, 2.99]); OR, 1.98 [1.27, 3.08]). There was greater risk of geographic atrophy for IHRF and hyporeflective drusen cores (P < 0.05), and
neovascularization for ellipsoid zone abnormality (P < 0.05). Other OCT biomarkers such as drusenoid pigment epithelium detachment, shallow irregular retinal pigment epithelium elevations, and nascent geographic atrophy exhibited large magnitudes of risk but required further studies for validation.
CONCLUSIONS: This
review synthesizes the 6 most relevant OCT prognostic biomarkers for AMD with greater predictive ability than large drusen alone, for clinicians and researchers to focus on. Further study is required to validate other biomarkers with less than high certainty of evidence, and assess how the copresence of biomarkers may affect risks.
BACKGROUND: The author(s) have no proprietary or commercial interest in any materials discussed in this article.