目的:脉络膜新生血管(CNV)通常被认为是最佳卵黄样黄斑营养不良(BVMD)的晚期并发症,并且可能难以用荧光素血管造影进行诊断。这项研究使用扫频源光学相干断层扫描血管造影(SS-OCTA)来评估BVMD中CNV的患病率,识别与CNV相关的结构特征,并深入了解CNV在卵黄样病变演变中的作用。
方法:机构审查委员会批准,回顾性,横向和纵向研究。
方法:分子确诊的BVMD患者。
方法:使用SS-OCTA成像的连续BVMD患者的图表(PLEXElite9000,Carl-ZeissMeditecInc,都柏林,加利福尼亚)从2017年9月至2021年10月在爱荷华大学进行了审查。临床数据包括年龄,性别,最佳矫正视力(BCVA),并记录玻璃体腔注射抗血管内皮生长因子(VEGF)治疗.由专家分级人员确定SS-OCTA上CNV的存在,并与诸如间质液等结构特征相关。视网膜下液,结节性视网膜下柱,局灶性脉络膜开挖和中心凹下脉络膜厚度,P值<0.05被认为具有统计学意义。
方法:在SS-OCTA上存在CNV并与SS-OCT的结构特征相关。
结果:共纳入27例患者的53只眼(13例女性;48.1%)。平均年龄为45岁(范围8-79),平均LogMARBCVA为0.38(范围0-1)。在SS-OCTA上发现CNV27只(50.9%),其中63.0%有卵黄样(Gass2期)病变。在40.7%(11/27)的眼睛中,以前没有CNV的临床诊断.与CNV相关的其他结构特征包括局灶性脉络膜挖掘(15.1%,8/53眼)和结节状支柱(15.1%,8/53眼)(p<0.01)。七名患者有纵向成像,这些患者中大多数在SS-OCTA上可见CNV(71.4%;10/14眼)。
结论:CNV在BVMD中很常见,包括在疾病的早期阶段。局灶性脉络膜挖掘或结节状柱的存在应增加临床对CNV的怀疑。这可能会加速卵黄样病变的演变。
Choroidal neovascularization (CNV) is usually considered to be a late-stage complication in Best vitelliform macular dystrophy (BVMD) and can be difficult to diagnose with fluorescein angiography. This study used swept-source (SS) OCT angiography (OCTA) to evaluate the prevalence of CNV in BVMD, identify structural features associated with CNV, and provide insight into the role of CNV in vitelliform lesion evolution.
Institutional review board-approved, retrospective, cross-sectional, and longitudinal study.
Patients with molecularly confirmed BVMD.
Charts from consecutive patients with BVMD imaged with SS-OCTA (PLEX Elite 9000, Carl-Zeiss Meditec Inc) at the University of Iowa from September 2017 to October 2021 were reviewed. Clinical data, including age, gender, best-corrected visual acuity (BCVA), and treatment with intravitreal anti-VEGF injections were recorded. The presence of CNV on SS-OCTA was determined by expert graders and correlated with structural features, such as interstitial fluid, subretinal fluid, nodular subretinal pillar, focal choroidal excavation (FCE), and subfoveal choroidal thickness, with a P value of < 0.05 considered statistically significant.
Presence of CNV on SS-OCTA and correlation with structural features on SS-OCT.
A total of 53 eyes from 27 patients (13 women; 48.1%) were included. The mean age was 45 years (range, 8-79 years), and the mean logarithm of the minimum angle of resolution BCVA was 0.38 (range, 0-1). Choroidal neovascularization was identified on SS-OCTA in 27 eyes (50.9%), of which 63.0% had a vitelliform (Gass stage 2) lesion. In 40.7% (11 of 27) of eyes, there was no prior clinical diagnosis of CNV. Other structural features associated with CNV included FCEs (15.1%, 8 of 53 eyes) and nodular pillars (15.1%, 8 of 53 eyes) (P < 0.01). Seven patients had available longitudinal imaging, and most of these patients had CNV visible on SS-OCTA (71.4%; 10 of 14 eyes).
Choroidal neovascularization is common in BVMD, including in the early stages of the disease. The presence of FCEs or nodular pillars should heighten the clinical suspicion of CNV, which may accelerate vitelliform lesion evolution.
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