视网膜色素上皮和外层视网膜完全萎缩并伴有眼窝中心受累的程度与视力有关

IF 3.2 Q1 OPHTHALMOLOGY Ophthalmology science Pub Date : 2024-08-29 DOI:10.1016/j.xops.2024.100612

Norihiro Nagai MD , Hisashi Matsubara MD , Hiroto Terasaki MD , Takao Hirano MD , Aki Kato MD , Akiko Miki MD , Hiromasa Hirai MD , Fumiko Murao MD , Hiroko Imaizumi MD , Fumi Gomi MD , Yoshinori Mitamura MD , Nahoko Ogata MD , Sentaro Kusuhara MD , Tsutomu Yasukawa MD , Toshinori Murata MD , Taiji Sakamoto MD , Mineo Kondo MD , Hajime Shinoda MD , Yoko Ozawa MD

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引用次数: 0

摘要

目的评估眼窝受累的完全性视网膜色素上皮和外层视网膜萎缩（cRORA）患者的 OCT 图像以及最佳矫正视力（BCVA），探讨视力损伤和萎缩的发病机制。方法评估眼科检查数据、BCVA、视网膜色素上皮和视网膜外层萎缩（RORA）的程度（以脉络膜过度透射和外丛膜层（OPL）恶化为代表）、视网膜中央厚度（CRT）和脉络膜中央厚度（CCT），这些数据是在切面 OCT 图像上使用内置软件测量的。结果 64 名患者的 64 只眼睛（平均年龄：76.8 ± 9.5 岁）中，38 只眼睛（59.4%）为男性。BCVA的平均值为0.602 ± 0.475（中位数：0.523；范围：-0.079至1.523），以最小解像角（logMAR）的对数表示。RORA 的平均范围为 2921 ± 1291（中位数：3172；范围：479-5985）微米。以 logMAR 表示的 BCVA 与 RORA 的范围（P = 0.004）和 OPL 的恶化（P = 0.004）呈正相关，与 CRT 呈负相关（P = 0.022）。最佳矫正视力≥0.5与RORA≥3000 μm（几率比[OR]，4.227；95% 置信区间[CI]，1.440-12.408；P = 0.009）和OPL恶化≥1700 μm（OR，2.984；95% CI，1.034-8.609；P = 0.043），以及存在完全中央外丛状层缺损（cCOD）（OR，12.700；95% CI，2.439-66.132；P = 0.003）。RORA 范围≥3000 μm 与 BCVA ≥0.5 相关（OR，4.213；95% CI，1.437-12.356；P = 0.009），OPL 恶化范围≥1700 μm 与 BCVA ≥0.5 相关（OR，58.682；95% CI，6.865-501.592；P <；0.001），以及存在 cCOD（OR，4.107；95% CI，1.339-12.604；P = 0.014）。结论眼窝中心受累的 OCT 图像中较长的 cRORA 与较长的 OPL 恶化程度、cCOD 的存在和 BCVA 的恶化有关。为了解RORA和视力下降的发病机制，有必要进一步研究OPL的变化。

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Extent of Complete Retinal Pigment Epithelial and Outer Retinal Atrophy with Foveal Center Involvement is Associated with Visual Acuity

Purpose

To evaluate the OCT images of eyes with fovea-involved complete retinal pigment epithelial and outer retinal atrophy (cRORA) as well as best-corrected visual acuity (BCVA) to explore the pathogenesis of visual impairment and atrophy.

Design

Retrospective observational study.

Subjects

Data of eyes with cRORA associated with age-related macular degeneration with foveal center involvement were collected from 10 hospitals in Japan.

Methods

Ophthalmic examination data, BCVA, and extents of retinal pigment epithelial and outer retinal atrophy (RORA), represented by choroidal hyper-transmission, and outer plexiform layer (OPL) deterioration, central retinal thickness (CRT), and central choroidal thickness (CCT) measured using built-in software on the sectional OCT images were evaluated.

Main Outcome Measures

Relationship between BCVA and extents of RORA and OPL deterioration.

Results

Of the 64 eyes of 64 patients (mean age: 76.8 ± 9.5 years old), 38 eyes (59.4%) belonged to men. Mean BCVA was 0.602 ± 0.475 (median: 0.523; range, −0.079 to 1.523) in logarithm of the minimum angle of resolution (logMAR). Mean extent of RORA was 2921 ± 1291 (median: 3172; range: 479–5985) μm. BCVA in logMAR positively correlated with extents of RORA (P = 0.004) and OPL deterioration (P = 0.004) and negatively correlated with CRT (P = 0.022). Best-corrected visual acuity ≥0.5 was associated with extents of RORA ≥3000 μm (odds ratio [OR], 4.227; 95% confidence interval [CI], 1.440–12.408; P = 0.009) and OPL deterioration ≥1700 μm (OR, 2.984; 95% CI, 1.034–8.609; P = 0.043), and presence of complete central outer plexiform layer defect (cCOD) (OR, 12.700; 95% CI, 2.439–66.132; P = 0.003), after adjusting for age and sex. The extent of RORA ≥3000 μm was associated with BCVA ≥0.5 (OR, 4.213; 95% CI, 1.437–12.356; P = 0.009), extent of OPL deterioration ≥1700 μm (OR, 58.682; 95% CI, 6.865–501.592; P < 0.001), and presence of cCOD (OR, 4.107; 95% CI, 1.339–12.604; P = 0.014), after adjusting for age and sex. The extent of RORA positively correlated with that of OPL deterioration (P < 0.001), CRT (P = 0.001), and CCT (P = 0.041).

Conclusions

A longer extent of cRORA in the OCT images with foveal center involvement was associated with a longer extent of OPL deterioration and the presence of cCOD and worse BCVA. Further studies focusing on OPL changes are warranted for understanding the pathogenesis of RORA and vision loss.